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Universal health care finds support

The government could extend health care to all American citizens and still save money by adopting Canada's national system, according to a draft congressional report to be released today. The General Accounting Office's study of Canada's 20-year-old health care program concluded that the United States has much to learn from its neighbor's government-run system, which streamlines administrative costs and reduces paperwork for physicians and hospitals.

"If the universal coverage and single-payer features of the Canadian system were applied in the United States, the savings in administrative costs alone would be more than enough to finance insurance coverage for the millions of Americans who are currently uninsured," the report said.

The savings might even be large enough to eliminate deductibles and co-payments insured citizens now pay, making health care free for everyone, said the GAO, a congressional investigative agency.

But the report said that on this point Americans might not want to replicate the Canadian system. Instead, the United States could combine the best of both systems, such as by continuing to require some cost-sharing for medical care and ensuring timely access to services.

Critics of the Canadian system often point to long waits in that country for some medical procedures and services. Some Canadians travel to U.S. hospitals for medical services so they don't have to wait months.

As the debate over the need for health-care reforms has accelerated in this country, some have focused on the Canadian system as a model with which the United States could provide health care for an estimated 35-million uninsured citizens and stem double-digit growth in medical costs.

"The economic rationing of health care under our current system could come to an end" under a Canadian-style system, said Rep. John Conyers, a Michigan Democrat and chairman of the House Government Operations Committee, who requested the report.

"People wouldn't be refused insurance because they have a pre-existing condition such as cancer. Families wouldn't be impoverished to care for a sick loved one," he said.

Health-care spending in the United States is expected to exceed $650-billion this year, accounting for about 12 percent of the gross national product. With no changes in the system, it is heading for a 15 percent share of the GNP by the turn of the century, experts predict.

The Canadian system provides health care for all the country's citizens, with no deductibles or co-payments, at a cost that is less than what the United States pays for a system that excludes millions of people and charges out-of-pocket costs for those who have insurance.

In 1989, per-capita health spending in the United States was $2,196, compared with $1,570 in Canada.

Health indicators also favor Canada: Average life expectancy of Canadian men is 73.1 years, while it is 71.3 years for American men, and Canada's infant mortality rate is lower.

Adopting a Canadian-style system would save about $67-billion in administrative costs, the GAO estimated. Universal insurance coverage without cost-sharing would result in about $64-billion in added costs, for a net savings of $3-billion, the report said.

But the GAO said "the potential costs of eliminating cost-sharing are the largest, most volatile and most uncertain factor affecting costs of movement toward a Canadian-style system."

"If the United States adopted universal coverage, we should consider retaining some form of cost sharing except for low-income persons to hold down the costs of implementing comprehensive reform," the report said.

"These cost savings could then be used to provide some leeway for the United States to improve upon the Canadian system and make it more acceptable to U.S. citizens," it said.