CANADIAN & U.S. HEALTH CARE POLICIES: (IR)RATIONAL CHOICES & SATISFACTION NOT GUARANTEED

This panel will begin with brief presentations comparing the Canadian health care system to the Affordable Care Act. The discussion will then focus on the radical idea underlying American health care reform: the best way to fix the system is to use the free market. Both Democrats and Republicans are convinced that what runs up the huge costs in the U.S. is too much health care, that is, wasteful spending. Patients "demand" extra, unnecessary services because their insurance pays; doctors and hospitals provide wasteful services because they get paid separately for each one. Reformers believe Americans are supremely rational consumers, experienced savvy shoppers. So the reformers' solution is to force consumers to pay more for insurance and health care: the theory is if they have to pay more for insurance, they will get skimpier policies with higher co-pays and deductibles that will push them to request only services they really need. On the provider side, the solution is to shift financial risk to doctors and hospitals, by "capitation," a fixed fee to cover whatever the patient needs. This recalls the "managed care" system proposed in the 1990s, which was met with public and political criticism. In addition to testing various theories, the panelists will explore the key concepts of patient and provider choice and satisfaction.