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A Different Way of Thinking About Health Care

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A Charleston, South Carolina man who thought he had pretty good health insurance may miss work today, as he has several times already this year, because of a hernia. He's in constant pain and needs surgery, but he has been postponing it. It's not because he's afraid of hospitals or going under the knife. It's because he can't afford the deductible.

I heard this story last week from a relative of his, Elizabeth May, who because she lives a few miles north of the U.S.-Canadian border has never faced such a dilemma. May was astonished to learn that many Americans, her cousin included, regularly postpone needed care because their insurance plans require paying several thousand dollars out of their own pockets before their coverage kicks in.

Of course, Elizabeth May is not just some ordinary Canadian. She is a Member of Parliament representing Vancouver Island in British Columbia and leader of the Green Party. I met with her and several other so-called MPs last Wednesday in Ottawa at the request of the Canadian Health Coalition, a group that wants to maintain and expand the country's publicly funded, universal access health care system.

May was not the only MP to share stories about Americans they've met who have fallen through the cracks of a system that fails to provide affordable health care to its citizens. Dr. Hedy Fry of Vancouver related the stories of three people who told California lawmakers at a hearing several years back that they had become "uninsurable" in the eyes of insurance companies after a major illness. Dr. Fry, the Liberal Party's lead expert on health care, also testified at that hearing. She had been invited to explain the Canadian single-payer system, which California lawmakers were considering. Her voice cracked as she recalled the dire straits those people found themselves in.

Dr. Fry's testimony clearly resonated. Legislators in Sacramento sent then-Gov. Arnold Schwarzenegger two bills that would establish a single payer system in the California -- in 2006 and 2008 -- but Schwarzenegger vetoed both, calling them "socialized medicine."

I also met with MPs from the other two major Canadian parties, including Terence Young of the Conservative Party and Libby Davies, the New Democratic Party's lead health care expert. And I had a chance to talk with the New Democratic Party's leader, Tom Mulcair.

Although Canadian lawmakers are debating how to ensure the continued financial viability of their system, which they call Medicare, no one in Ottawa of any ideological stripe would dare suggest doing much tinkering. Canadians talk with pride about their health care system, about how it is part of the country's DNA.

I told the lawmakers and others how my colleagues and I in the health insurance industry worked over several decades to scare Americans about the Canadian system by perpetuating myths about long waits for medically necessary care. What scares Canadians, by contrast, is that lawmakers might unwittingly enact reforms that would lead the country down a "slippery slope toward American-style health care."

The people I talked with were especially alarmed to learn that millions of Americans who have health insurance file for bankruptcy every year primarily because of medical debt. Most of those folks are in health plans with high deductibles who learn after being treated for a major illness or injury that they are on the hook for thousands of dollars.

Meanwhile, back in the states, Karen Ignagni, the CEO of America's Health Insurance Plans, claimed during a recent C-SPAN interview that people longed for the days when insurance companies could sell policies that make people pay more of their own money for care than the Affordable Car Act allows.

The ACA permits insurers to sell policies in four tiers -- platinum, gold, silver and bronze -- that have varying levels of cost sharing. Enrollees in platinum plans generally pay up to 10 percent of health care costs before their coverage starts. Bronze plan enrollees pay up to 40 percent. Premiums for platinum plans are among the highest while premiums for bronze plans are among the lowest.

Ignagni said Congress should consider allowing people to buy policies that require them to pay even more than 40 percent of their total medical costs.

"That's what people preferred to buy because they wanted to keep their premiums low," she said.

There is no doubt that many people would like to pay lower premiums, but allowing insurers to sell coverage that almost guarantee that policyholders are underinsured the moment they buy them is not the direction we should be heading. Elizabeth May's cousin, who has not had the surgery his doctor says he needs because he doesn't have the money to cover his high