The issue of wait times, when it comes to emergent care, canadians are not waiting substantially longer than our peers in other countries including the United States. Unfortunately, it was true that has not been the case for medical care such as nondiagnostic imaging. A great deal of work was underway to address this challenge. And indeed, waits have been decreasing over the last decade. It is important to note that moving away from a single payer model would likely exacerbate our wait time challenge rather than alleviate it by drawing Critical HealthHuman Resources out of the public system. This is bourn out by International Evidence from other jurisdictions such as australia. The canadian system is proof that Public HealthCare Insurance need not be provided federally in order to achieve the benefits of the single payer model. In canada, each province provides Public HealthCare Insurance to its residents with minimum standards set at the federal level. Furthermore, moving to single payer insurance as youve heard does not necessarily mean moving to the direct provision of Health Care Services by government or socialized medicine. Although our provincial Health Insurance plans in canada are financed publicly, almost all Health Care Services are delivered by private entities. This includes our hospitals, which are mostly independent, not for profit entities, and also our providers, most notably physicians who are not employees of the state, but rather independent contractors who happen to bill a public Insurance Plan for their services. I want to reiterate my thanks to the committee for giving me the opportunity to present to you today. I look forward to your questions and engaging in dialogue. Thank you very much. Senator byrd, do you want to introduce your other guest . Thank you, mr. Chairman. Id like to introduce to my colleagues, dr. David hogeberg at the National Center for Public Policy research here in washington, d. C. Thank you for joining us today. I look forward to your testimony and thoughts as we examine the Lessons Learned from other abroad countries in order to strengthen our own Health Care System here at home, the mike is yours. Chairman sanders, Ranking Members burr, members of the committee. Thank you for this opportunity to testify before you. My name is david hogberg. I think the most important lesson we can learn from other nations is that we should avoid putting more and more of our health care. A substantial impact on policy. Reelection chances are more likely to get good treatment under government run Health Care Systems. Groups that lack such cloud are more likely to be neglected by politicians and receive inferior care. Too limited to have much impact on elections. Second, they are too sick to engage in the type of political activity such as organizing, protesting and so forth. Those with the most medical need are those most likely to have the difficulty getting the care they need. Denmark and france provide good examples of this. Could be described as single payer with over 85 of health care expenditures. Largely free at the point of consumption. This has consequences for how Health Care Resources are allocated. If patients pay nothing at the point of consumption, theyll overusE Health Care putting strain on government budgets. Health care systems must be Health Care Must be rationed in another manner. 48 days to get a herniated disk repaired. 37 days for a Knee Replacement and 81 days for cataracts treatment. By the time of treatment. However, a 2010 study found that head or neck cancer were treated within that national standard. About 3. 7 . Now, looking to the french system, health care in france is financed heavily through the government also has an extensive market that covers copayments and services the government does not cover. When a patient visits a physician in france, he must pay the cost directly. Hes reimbursed by the government and the private insurer. Must cover any cost that is not reimbursed. The method of payment and the extensive system of private finance is what allows france to avoid using wait times to ration care. Running a deficit since 1988, as a result, the Health Care System in france has used other methods to ration care. One rationing method is limiting investment in new medical technology. Among industrialized nations, france has one of the lowest numbers of cat scanners, pet scanners and mri machines per million population. Rationing pharmaceuticals is another method. In brief, the french government often refuses to pay for drugs that are incremental improvements over existing drugs. Such rationing has consequences. According to one study, only about 1 4 to 1 3 of alzheimers patients rationing technology and medication or using waiting times falls hardest on people with serious illnesses. They do not cause trouble for politicians since the people selected seldom are a political force. The chief benefit of an examination of other nations Health Care Systems discover what policies we should avoid. It would be productive if we instead studied other markets rather than other nations. There you will find markets in which government tax policies havent distorted the purchase of goods or tax policy and regulation. And consumers are not prohibited from buying goods and services out of state. As a result, these markets reduce the cost of goods and services while also improving quality. It is in these markets we should look for guidance in reforming the u. S. Health care system. Thank you very much. Thank you very much. Our last but not least witness is jacob kelberg. Mr. Kelberg, thank you very much for being with us. Thank you, chairman sanders. And Ranking Member burr. The members of the committee. I would like to thank the opportunity to participate in this hearing. Ive been asked to give an overview of the danish Health Care System. The danish Health Care System is an example of comprehensive and universal coverage for all patients. No patients may be denied services on the basis of health care, employment status, age or Health Status. Most patients in denmark are listed with a gp of their choice. And the use of all Specialized Health services is free with a referral from the gp. Patient could also choose group two Health Insurance and specialized treatment directly. People are generally quite satisfied with the gp system. If referred to hospital, patient may choose among all Public Hospitals offering the relevant treatment. All hospital treatment is free, including all hospital drugs. Patients may choose among private hospitals in denmark or abroad if the waiting time exceeds one or two months depending on the condition. Many patients prefer to stay with a local hospital therefore median wait cant be longer than the waiting time guarantee. But its a choice. If cancer is suspected, we offer twoweek waiting time for examination and treatment. It has previously been a problem as you mentioned. To finance the Health Care System, the state collects the necessary revenue through general taxation. Funds the region on basis of objective criteria. This ensures equal opportunity across the country. The simplicity of the financing structure also keeps the administrative costs low. Only 4. 3 of the total Health Spending is used for administration. The Public Sector finances about 85 of the total health expenditure. Mainly covers out of pocket payments for primary sector pharmaceuticals, dentistry and Optical Services like glasses and contact lenses. About half of the population has supplementary Health Insurance to cover the out of pocket payments. Now all the supplementary Health Insurances where you can Access Health care quicker than one month or two month waiting time guarantee or free access. But the supplementary Health Insurance covers less than 1 of the total health care budget. But its a choice. Can be characterized being good. 85 of the population perceived their own Health Status as excellent or very good. The Life Expectancy is on average 80. 1 years. Historic high smoking rates is relatively low Life Expectancy in denmark compared to other nordic countries, not the system or the health system. The european Consumer Power house ranks all the european Health Care Systems. And here the danish Health Care System ranks second in europe. A system ranks second in europe. High on patient rights, range and Services Provided and information. Low in preventionnd health in denmark, when you look at the statistics. However, denmark has a practice of reporting for social care as health expepdatures, if the costs were reported in line with most other countries, it is kig santly below average. To sum up, the system is an example of a transparent Health Care System that provides comprehensive and use of universal coverage and high levels of patient satisfaction. The simplicity of the system keeps low cost and makes it easy for the patient to Access Health care. I would be happy to answer any questions you might have. Thank you for the attention. Thank you very much, mr. Hav kelberg. Now well begin with questions and comments and let me let me begin let me begin by asking all of our distinguished panelists a very simple question. In the United States today, we are the only nation that does op not guarantee People Health care is a right. Le h and we still have the numbers have gone down since the e Affordable Care act. But we still have many, many afd millions of people who have no Health Insurance at all. Others have highmill p copaymen deductibles. Let me ask all of the panelists a simple question. Be should health care be a right of all people regardless of incomes yes, no, maybe . Should health care be a right of all people . I think it should. I think it should because it is it is a sign, an expression of a civil society. Okay. The brief answers. As health care, their income a right in our constitution. Ght in okay. Miss pipes . No, were entitled to life, r liberty and thede pursuit of happiness. How do you determine which right is worth more . Do we have a right to housing . A right to food . A a right to health care . How do you measure which is the appropriate level . So, no. Okay. Thank you. Dr. Martin . Yes, access to health care i . A human right. And i i know that the vast majority of canadians in poll after poll feel the same way. Mr. Kelberg. Yes, i believe that access to health care should be a right. Dr. Hogberg . Ld b yes, i believe it should be a right in the classic liberal asa notion that rights that government should not interferen congress should make nogr law ao so forth. So, yes, everyone should have the right to health care in that sense. An doctor . We have a right for health carerigh in the United States fi emergency care. I believe that should be extended to primary care, as ed to okay. Pr let me state on that point, maybe get to dr. Hogberg. Olberg you indicated you thought health care should be a right, a government should not be involved in that process. Its a moot point. No, its not. But im asking you as an academic. Youre not youre right, its a Popular Program. Is but if you say government shoulf not be involved in health care and medicare is a Government Health care program in your judgment i and the best of all a yourre possible worlds, should vote to get rid of medicare . Some people think we should. Sho . Its a moot point, its here to stay. I believe we are not going to get rid of medicare. Medicare is a program for our seniors. I believe we have severe problems. The medicare trusteeesoble saidt medicare would be bankrupt by 2024. At a cost of over 1 trillion. I wanted to ask you a simple question. Government is medicare is a government run program. Nt as dr. Hogberg indicated. I think its a Popular Program. My question is, should, in yourr judgment, we abolish this we governmentrun Medicare Program. Not entirely. Me medicare should be there for those people who truly need it. A the problem is truly needed. But not as it is right now. A lot of people wealthy can e afford care. Well, not a lot of people cost pressure on the system. Paul ryan let me congressman ryan, i think has very good ideas. He would transform medicare into a voucher program. Let me ask you a question. Despite the fact that our Health Care Outcomes are not particularly good. Of in terms of Life Expectancy, ths United States ends up spending twice as much money per person on health care as any other nation. Why is that . And im going to leave you well give senator byrd additional time, as ll. Why is that . We spend more for several reasons. First, our prices are higher than all other wealthy oecd we nations. If a woman has birth in thiss country compared to france, how much more does it cost . Or give me some examples . Ared it can cost different priceso for all to see. Ne so price is very important. V prices of drugs, prices of how do drug prices compare in the United States compared to other countries . So if i needed a cancer drugi in the United States,s why is i more expensive here than it is in canada or france . Ada you have regulated prices for these drugs and people have access to them. That interferes with the freo market system. Is that a good idea . Of course it is. That is operational and works. Its a fine idea in theory. But i challenge anyone to give me one, one concrete example. All the evidence suggests that it does not work. Okay. Canadian doctors exiting the public system for the private sector has had the effectively increasing waiting. Why are doctors exiting the public system in canada . Thank you for your question, senator. If i didnt express myself in a way to make myself understood, i apologize. What i did say was that the solution to the wait time challenge that we have in can a canada, which we do have a ich we difficult time with waits for elective medical procedures doe not lie in moving away from our single payer system to a multipayer system. Multip and thats bourn out by the experience of australia. Paye andr a very well known study wa tracked. What took place in terms of waik times in australia as the multipayer system was put in place. And what they found was in thosh areas ofat australia where prive insurance was being taken up and utilized, waits in the public system became longer. What do you say to an elected official who goes to florida and not the canadian system to have a heart valve replaced . Well, its interesting, the people who are the pioneers of that particular surgery which premier williams had and had the best outcomes in the world for that surgery. So what i say is sometimes, sometimes people have a perception. M i believe this is actually eptin fueled in part by media discourse. That going to where something where you pay more for something that necessarily makes it that better. Necessar but its not actually bourn outr by the evidence on outcomes. One would believe the outc American People prefer their system because they know consciously they pay more. I think its because they judge quality and judge innovation. P they feel their health is at stake. A lot of people in canada come to the u. S. For mris, ct scans. There are many examples in the a media of people like brian mcekreath came to the u. S. Because he was told he might pa have a brain tumor but the wait for an mri was very long. He spent the 1,000, came to the u. S. , paid out of pocket. In a way thats equitable for all. What length of time do you consider to be equitable when waiting for care. Benchmarks across a variety of different diagnoses of whats a reasonable period to wait. We found that actually working within the single payer system,t we can reorganize things, you e know, ive waited more than 30 minutes at the security line to3 get into this building today. And when i arrived in the lobby, i noticed across the hall, there was a second entry point with no line up whatsoever. Sometim in order to use your cues most effectively. And we believe when you try to address wait times, you should n do it in a way that benefits everyone, not just people who can afford to pay. How many patients on a o waiting list die each year. Howm i know there are 45,000 in america die waiting because they dont have insurance at all. The american system has access for everyone. Its called the emergency room. Now, we dont