Most people assume that insurance is an essential part of the health-care system. Some think it should be provided through public programs like Medicare, while others prefer to see it purchased from private insurance companies, but the majority believe that insurance is needed to help pay the unpredictable and often catastrophic expenses of medical care. That is why so much public policy focuses on extending coverage to as many people as possible and controlling its cost. I think this emphasis on insurance is mistaken.
Canada, of all places, is having a highly charged national debate about whether to adopt the U.S. model of commercialized health care as part of its national health-insurance system. Health policy makers in Canada, particularly at the provincial level where most practical decisions are made, are being told a monstrous myth. Consultants and business people, often with little professional health training or experience but with ample conflicts of financial interest, are extolling the advantages of marketplace medicine and the benefits that an American-style entrepreneurial approach would supposedly bring to the stressed Canadian system. And yet the U.S.