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Canadians have some pride. AP Photo Sean Kilpatrick
This the the fourth part of a five part series on health care reform. Click below to see any of the other pieces:
Part two: Can I keep my current insurance?
Part three: Will health care be rationed under reform?
In this part of the series we analyze the much maligned Canadian health care system. Conservative commentators have attacked the Canadian health care system and others like it since the health care reform debate began. The Canadian system has been pictured as a virtual hell where people wait forever to get health care, or die while waiting for care, or are denied procedures by government bureaucrats. Frequently stories are told of Canadians patients who were made to wait for procedures and came to the haven that is the United States health care system to get the care they needed. So is Canada truly the government run hell it is depicted to be or more like a heaven of socialistic medicine?
The truth, as usual, is something in between the two extremes. Does Canada have problems in its health care system? Absolutely. Does the Canadian system match with the horror film depiction of the Republican party? Absolutely not. In analyzing and health care system which is as complex and vast as the Canadian and American system it is not useful to focus on individual anecdotes. After all, if you look into any systems covering that many people you will always be able to find some failures. One needs to only watch Sicko and Jon Stossel reports back-to-back to find multiple stories of people who have been failed by both systems. Instead, we should focus on the overall data from each country to judge which system is superior.
First a description of the two systems. The United States system is a mix of public and privately funded care. Public funding provides about 45% of the funding for all the health care in the United States. This funding consists of Medicare, Medicaid, care provided for the military, and government subsidies. The other 55% of health care is paid for through private individuals either through paying for insurance or through out-of-pocket expenditures. According the Organization for Economic Co-operation and Development Canada pays for about 69-75% of its health care with public funds. The major difference between the two systems is that in the United States health care is dominated by private insurance companies who provide policies bought by employers and individuals. In Canada, private insurance is virtually non-existent and the government pays for nearly all care. So in Canada there is one major major source of funding through which all health care services are billed and all citizens generally have a right to necessary, but not cosmetic, medical coverage. Now that we know the major differences between the two systems let us compare them on the major issues of health care.
Costs:
The data reveals that Canadians actually spend significantly less on health care even while attempting to provide coverage for all. The Canadian government spends an average of $2120 per person on health care while in the United States the government spends $2724 per person. In the United States we also spend significantly more on private expenditures which amounts to $3372 per person while in Canada the average person spends a mere $917 per person. The reason being, of course, in Canada nearly all care is funded by the government. Finally, as a percentage of GDP Canada spends 10.1% of its overall wealth on health care while the United States spends 16.1%. Overall by any measurement Canada spends significantly less than the United States on health care.
Coverage:
The Canadians also better the United States in overall coverage of their citizenry. In the United States some 45.7 million people lack any health insurance which constitutes 15.3% of the U.S. population. Conservatives correctly argue that some of those people qualify for Medicaid or Medicare and some more have incomes that would allow them to purchase insurance if they chose to do so. However, even accounting for these groups the United States system still leaves millions with no health insurance at all. In addition, some 24% of the American population is severely "underinsured" carrying bare-bones insurance that would not cover major medical expenses. Consumer Reports concluded that overall some 40% of the American population lacks adequate access to medical care.
Contrary to popular belief, however, the Canadians do not provide coverage to all of their citizens. Some 5% of the Canadian population reports not being able to find a doctor. The problem is most severe in the Northern parts of Canada where hospitals and doctors are more sparse. Still even accounting for this percentage of people the Canadians cover far more of their citizenry.
What effect does this coverage have on actual health care provision? Overall, in comparing the two countries one study concluded in the United States a third less likely to have access to a regular doctor, one-fourth more likely to have unmet health care needs, and twice as likely to go without needed medicines.
Wait Times:
Oh but what about those infamous wait times in Canada? In fact Canadian wait times can be long and many times exceed the suggested time as "clinically reasonable." The wait times vary greatly by province within Canada. In some areas the wait can be close to zero while in other areas the wait can be more extreme due to lack of hospitals and/or doctors. The most extreme of these wait cases have been portrayed in American media outlets. Overall, despite the wait time as large majority of the Canadian citizenry is very satisfied with their level of care.
The myth in this areas deals not so much with the system in Canada but rather with that of the United States. The myth is that in the American no one waits for care. For sure those with the money to pay for care can get quick access but those with less income often must wait just as long as Canadian if not longer. For example, many patients on Medicaid have reported wait times of over three months simply to see a doctor. The facts are the world lacks an adequate amount of hospitals, doctors, and nurses. Until that problem gets solved wait times will be a struggle for every country.
Quality of Care:
It is true taht more top-of-the line technology and drugs are "available" in the United States. For example, in America we have nearly four times as many MRI scanners as in Canada and nearly three times as many CT scanners. Unfortunately, very few studies have been done to show whether the United States technological advantage actually leads to healthier outcomes for patients. The conservative media focuses on stories of political leaders from other countries who come to the very best U.S. hospitals for care. While these stories are interesting they hold little weight in the overall debate. It has never been a point of contention as to whether the richest Americans or foreigners could get quality care in the United States. Without a doubt those who can afford can get the very best care. The question is whether this "top-of-the-line" care for a few is worth given the sacrifices of the rest of the population. The state above on overall access to care suggest the overall population of America may suffer compared to that of Canada.
Health Outcomes:
There are many stats one can look at in examining health outcomes for a nation. Conservatives like to point to cancer survival rates in the United States which score much better than Canada. Overall, however, the numbers once again side with Canada. The average life expectancy of a Canadian is 81.2 years compared to 78.1 years for Americans. Infant mortality in the United States is 6.4 per 1,000 live births while in Canada it is a mere 4.6. A lower number is obviously good as, for example, Angola suffers from an infant mortality rate of 184.4. Finally one study which comprehensively analyzed all other studies on health outcomes of the two countries found that out of 10 studies with significant statistical data 5 favored Canada, 2 favored the United States, and 3 had mixed results.
Conclusion:
In America we spend more and yet still receive less health care overall in comparison to our Canadian friends up North. Perhaps instead of trying to run away from the "we will become Canada" argument the Obama administration should simply concede the argument. In reality, the plan proposed by Democrats has significant differences with the Canadian system. Most importantly, the United States system at least intends to maintain a private insurance system. Still, without a doubt the Democratic proposal would make our health care system more similar to the Canadian system. If this is true the data above reveals that actually may not be bad thing.
Comments
wow, nice job using studies of your choice and omitting facts. The reason care is so cheap in Canada and Britain for 3 reasons.
1)they dont invent any new technology or create cutting edge treatments. Fact: the USA invents 85% of new medical technology. This allows other countries to have socialized medicine because they leech off us.
2) They only have a population of 80 million as opposed to 320 million in the USA
3)The government run system cuts back on expensive life-saving treatments because only a few thousand people will benefit from it. What if you or your child are those few thousand?
Look what happened in Britain, the government decided to stop buying life-saving drugs for a rare stomach cancer because less that 1% of the population has the disease. Thats still a few thousand people who are now condemned to die if they cannot get the drugs elsewhere!
USA healthcare system is expensive because of the 45% public funding. Medicare has been in the red for 30 years!
crazyconservative:
You have no idea what you're talking about.
First of all, there is quite a healthy medical R&D industry in Canada.
Second, learn to do math. The costs being cited were PER CAPITA costs and % of GDP costs. The size of the population is irrelevant to those numbers. It's a measure of cost efficiency of the system. In fact, if anything a larger population should be doping BETTER, insurance works best and most efficiently in larger risk pools that are better able to spread the cost of catastrophic point failures across the entire population. But the US insists on using a system that destroys it's ability to take advantage of this by dividing the patient population into a thousand piecemeal segments served by hundreds of different profit seeking private insurers.
to be continued...
continuing...
Third, I think you have government confused with private insurance. It is profit seeking corporations that cut back on the expensive treatments. That's why in Canada it's your doctor who decides if you need a treatment or not, in the US it's your doctor... IF the accountant at your insurance company tells him it's ok and they'll pay for it. And it is the JOB of that accountant to say no if he can figure out any excuse to do it. Or to figure out a way to just dump you from your coverage if he can't do that.
And medicare is in the red because the US system is idiotic. It dumps all the highest risk highest expense patients into that system then turns over all the younger, healthier, profitable patients to the private insurers. Of COURSE medicare is in the red!
Ryan:
While isolated looks at cancer studies may look good for the US:
http : // www.openmedicine.ca/article/view/8/1
That's a bit more thorough, and tells a different story on comparative health out
Note: I had to insert some spaces in the address of the link below since for some reason the comment box won't accept proper links.
crazyconservative
* * *
SAD very sad,
once again it just shows not only do most south of here know very little about what happens here.
Yes we only have 30 million here.
AS for cutting edge medical breakthroughs, sad again you have done little to research as well, but that's okay.
If your sick we wont stop you from using any new vacances or technology developed here.
Crazyconservative:
You are crazy, as your name indicates. I hope you posted in jest. Certainly journalists have their own perceptions, no one can be free of their biases. However, this article cites credible, independent sources
Where is the citation of your "fact"? Governments and private industries throughout the world invest in new drug R & D. Let's say, however, the U.S. does create 85% of the new medical inventions. Under the mixed private-public Obama plan, companies like Pfizer would still have the incentive to create drugs to sell to the government and to people who chose private insurance. The government funds a large portion of medical R & D, and could continue to do so.
Canada's population is closer to 33 million, check your "facts".
1% of Great Britain would be about 607,000 people. I guarantee that no post-modern government would allow that scenario to play out.
Good article.
Robert Moon is spamming The Activity Pit again: twi.cc/lAlq
Nice article.
Nice article, poor grammar.
The 'doctor shortage' in Canada was the result of Medical Associations' successful lobbying to have enrolment in medical schools capped at artificially-low levels. This created a scarcity of doctors--hence, a sellers' market for their services (putting more pressure on the Provincial governments over fee schedule negotiations, allowing pickiness over patients). Medical school admission also still requires an undergraduate degree, even one completely unrelated to medicine. This drives up education costs. Cut the programme to four years (right out of high school), open up enrolment and you've solved the supply problem.
The big problem is the concept of self-regulating professional associations and licensure. Professions really are just medieval guilds, running a closed shop. Conservatives (e.g., the Fraser Institute) who call for 'free market' medicine--WITH the Associations--are hyppocrites. Medicine has to be de-unionised and licensure undertaken by governments.
Ryan Witt, are you an ACORN "community organizer"? You have deleted most of the comments critical of the Obamacare scam. You are obviously trying to help the dictator lie and manipulate people into swallowing the Obamacare scam.
Regarding the healthcare system in Canada, Canadian Medical Association President Dr. Anne Doig says her country's health-care system is "sick" and "imploding."
For meaningful statistics rather than anecdotes, check out the numbers surrounding medical tourism. Apparently, between 60,000 and 85,000 foreigners traveled to America last year to receive medical care. Why would these people come to America if we have lousy health care? It's because we actually have some of the best hospitals and doctors in the world.
Yes, we do need to solve problems, but Obamacare has NOTHING to do with solving problems. It’s just a CRIMINAL SCAM, like cap and trade, to enslave us.
AntonioSosa, et al.,
To reiterate, "CANADIAN MEDICAL ASSOCIATION President Dr. Anne Doig" says the system is 'imploding', because her and her union buddies want to have their cake and eat it: government-subsidised education, malpractive insurance and billing, PLUS the 'right' to extra-bill, or charge what the market wants to bear. I find it very ironic and funny how vulgar Marxist the 'free market' doctors are--they want the right to charge 'market' rates and claim to believe in 'freedom', but continue operating as a closed shop. The presence of medical associations and the existence of professional licensure automatically makes all this 'free enterprise' talk a hypocrisy. The needs of patients have to come first--before either financial companies, OR unions--and that means busting the medical associations and turning licensure over to a PUBLIC body.
Obamacare is a multibillion dollar porkbarrel for HMOs, pharmaceutical firms and IT firms like Microsoft--NOT 'socialism'.
Canadians live, on average, THREE YEARS longer than we do. SOURCE: www.cia.gov/library/publications/the-world-factbook/rankorder/2102rank.html
Clearly, they are doing things better than we are.
Canada ranks 7th in the world in average longevity. The US? 49th.
THREE YEARS MORE? SEVENTH?
THREE YEARS FEWER? FORTY-NINTH? Take your pick.
You have people that live in countries with socialized medicine coming here for medical care. What does that say to you? Help us stop Obamacare and sign the only REAL repeal out there. http://bit.ly/therepealpledge
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