When it comes to fighting for the creation of a U. S. government-insurance plan to remedy the health-care crisis in the United States, President Barack Obama has almost three-quarters of the American public in his corner.
Republican opponents, on the other hand, have Dr. David Gratzer, a Manitoba-born physician who came to Capitol Hill last week armed with a stack of statistics about patient wait lists in Canada, and a fusillade of dire warnings about the life-threatening consequences of government-managed care.
An unfair fight? Not so fast. With the clock ticking on Mr. Obama’s August deadline for passage of health-care legislation in the House of Representatives, it’s not entirely clear whether the President of the United States, or a self-described libertarian from Winnipeg, has the upper hand.
“The public option is polling well. That gives Democrats the edge,” Dr. Gratzer said in an interview after four hours of testimony last week before the powerful House Ways and Means Committee.
“That being said, they are getting bogged down with the legislation. If they can’t pass this by the August [congressional] recess, it’s a whole different ball game. If we can take this into the fall, I think everything is going to be on the table.”
For veterans of the political battles in Ottawa over Canada’s health system, Dr. Gratzer is a familiar personality. He made his name a decade ago in Canada, following publication of a book, Code Blue: Reviving Canada’s Health Care System, which argued the country’s public health system was failing. It won Canada’s Donner Prize for best public-policy book in 1999.
Now a senior fellow with New York-based Manhattan Institute, Dr. Gratzer has emerged as the go-to expert witness for GOP lawmakers hoping to sow doubt in Congress about the wisdom of embracing Mr. Obama’s call for a public-health-insurance option to compete with private insurers.
Twice this month, he has sparred with senior Democratic proponents of a government plan to help cover the nation’s estimated 48 million uninsured residents. And he’s taken his hits.
Former Democratic presidential candidate Dennis Kucinich, in a particularly testy exchange, peppered Dr. Gratzer with a series of questions challenging Dr. Gratzer on his claims of unreasonably long Canadian wait times. Dr. Gratzer, unable to get in a word, finally protested: “Am I allowed to answer?”
At the Ways and Means committee, one Democrat accused Dr. Gratzer of putting Canada’s single-payer system up as a “straw man” to distort the plan Mr. Obama is actually offering.
Dr. Gratzer took the sometimes hostile reception in stride.
“Churchill once commented on the Boer War that there is nothing so exhilarating as being shot at and not killed,” he joked afterward.
On the substance of U. S. health reform, however, Dr. Gratzer is deadly serious.
The most dangerous part of Mr. Obama’s plan is that a government-managed system would cripple private insurers by luring Americans into the Washington-run plan, Dr. Gratzer says. He cites one study, disputed by Democrats, that estimates 120 million Americans would abandon their current insurance if a government program emerged.
Under that scenario, the U. S. government would become the biggest health insurer, with the power to mandate doctors’ fees the private sector could not match, he contends.
More worrisome, Dr. Gratzer says, the government would ultimately try to lower health-care costs by rationing care.
The U. S. system would eventually look a lot like Canada’s, with doctor shortages and long wait times for specialized procedures ranging from MRIs to knee surgery to cataract removal, he says.
“Americans will get good coverage with bad access — not unlike Canada,” Dr. Gratzer says. “There are no uninsured in Canada, but one in six Canadians can’t find a family doctor, according to Statistics Canada. I think those are the problems one would see in the United States.”
The forces of Dr. Gratzer’s argument won some unlikely praise from Representative Charlie Rangel, the Democratic chairman of the House Ways and Means committee. But it didn’t change Mr. Rangel’s mind.
“You are very persuasive,” Mr. Rangel told Dr. Gratzer.
But Mr. Obama’s public option “is a far cry from what you describe as socialized medicine, or whatever derogatory term that you want to call it,” Mr. Rangel said. “We are not competing for a French plan or a Canadian plan or a foreign plan.”
Arguments such as Dr. Gratzer’s played a key role in the defeat 15 years ago of former president Bill Clinton’s plan to reform U. S. health care. But public sentiment about government involvement has shifted.
A New York Times/CBS News poll this week showed 72% of Americans supported a government-administered insurance plan to compete with private insurers.
Still, opposition among Republicans — particularly in the Senate — has forced Mr. Obama to repeatedly defend his plan against claims it would drive private insurers out of business.
The public option would be part of a health-care marketplace — or exchange — and Americans could choose the best option, Mr. Obama says.
“If private insurers say that the marketplace provides the best quality health care … then why is it that the government — which they say can’t run anything — suddenly is going to drive them out of business?” Mr. Obama says. “That’s not logical.”
But Dr. Gratzer contends the public health option “is not true competition and it’s not true choice,” because the government would likely be able to arbitrarily set doctors’ fees and price structures.
Dr. Gratzer favours reforming the U. S. system, but says its greatest problem is runaway costs — health-insurance premiums have almost doubled since 2000 — and not the number of uninsured Americans.
“There is maybe a core group of 8 to 10 million who fall through the cracks,” he says.
“That is too many Americans. Something ought to be done. That doesn’t necessarily justify a $1.6-trillion government expansion that the House Democrats are flirting with.”