Medical Care in Canada, United States

Americans, primarily out of ignorance, have long considered Canada little more than an economic and cultural appendage of the United States. Kenneth Freed’s penetrating analysis of Canada’s health-care system (May 19) should put such fatuous notions to rest, at least insofar as access to high-quality medical care is concerned.

In 1948, President Truman offered the American people a comprehensive universal national health insurance program that was never enacted, thanks to the American Medical Assn. and its army of high-powered lobbyists and well-heeled campaign contributors. Even Medicare, signed into law by President Johnson in 1965, has so many deductibles and exclusions that today few of its beneficiaries can afford to go without expensive private “Medigap” insurance.

As a physician who has long believed that medical care is a right, I am appalled at how little this country is doing to provide people with the kind of humane compulsory health insurance benefits available in Canada and other industrialized nations.

Such programs, no doubt, are expensive--Freed did not explain how Canada funds its provincial health plans--but they can’t be any more costly that the hodgepodge of private insurance, Medicare, Medicaid, Medigap, county hospitals and formidable out-of-pocket expenses currently facing the average American patient.

I believe that the best approach to eliminating the inequities in our present system should be through a combination of value-added or excise taxes and a choice of providers modeled after the federal and State of California employee health benefits programs.

Under these plans, employees and their dependents can select from among several federally qualified health maintenance organizations or fee-for-service insurers through contracts negotiated each year by the state or federal government. Those who choose to join an HMO, for example, generally find themselves responsible for fewer out-of-pocket expenses than under fee-for-service arrangements. In any case, no state or federal employee ever has to suffer the indignity of a means test or risk bankruptcy because of astronomical medical bills. Surely, such a benefits package should be extended to other members of society.

It is time that we in the United States follow Canada’s lead--and fulfill President Truman’s dream--by enacting a comprehensive universal national health insurance program for our own people.

HAROLD N. BASS MD

Northridge