The Not-So-Awful Truth About Canadian Health Outcomes
Toronto General Hospital (Wikimedia)
Someone was on Fox earlier this morning arguing that including a robust public plan in health care reform would lead the United States to a Canadian-style health care system, which would be terrible. This is closer to the mark than Oklahoma Senator Tom Coburn’s insistence that a public plan would be like the Veterans Health Administration, which he (also falsely!) claimed would be bad. Advocates of a public plan are proposing something very different from the Canadian health insurance system. But if a public plan were introduced, and then it succeeded in delivering consistently higher-quality, lower-cost care than all private insurance companies all across the country, US health care could evolve in a direction that would in some respects resemble Canada’s. How likely that really is is up to debate. But it could only happen if customers were to show a consistent and overwhelming preference for the public plan, in which case the public plan coming to dominate probably wouldn’t be such a bad thing.
Meanwhile, how’s health care in Canada? According to actual research it’s about the same as in the United States:
Objectives: To systematically review studies comparing health outcomes in the United States and Canada among patients treated for similar underlying medical conditions.
Methods: We identified studies comparing health outcomes of patients in Canada and the United States by searching multiple bibliographic databases and resources. We masked study results before determining study eligibility. We abstracted study characteristics, including methodological quality and generalizability.
Results: We identified 38 studies comparing populations of patients in Canada and the United States. Studies addressed diverse problems, including cancer, coronary artery disease, chronic medical illnesses and surgical procedures. Of 10 studies that included extensive statistical adjustment and enrolled broad populations, 5 favoured Canada, 2 favoured the United States, and 3 showed equivalent or mixed results. Of 28 studies that failed one of these criteria, 9 favoured Canada, 3 favoured the United States, and 16 showed equivalent or mixed results. Overall, results for mortality favoured Canada (relative risk 0.95, 95% confidence interval 0.92-0.98, p= 0.002) but were very heterogeneous, and we failed to find convincing explanations for this heterogeneity. The only condition in which results consistently favoured one country was end-stage renal disease, in which Canadian patients fared better.
Interpretation: Available studies suggest that health outcomes may be superior in patients cared for in Canada versus the United States, but differences are not consistent.
If you ask me, health care in the United States is not so great, so Canadian health care—which turns out to be of similar quality—is not so great either. But it’s a lot cheaper, so that’s nice. Alternatively if, like most conservatives, you deny that our system is broken and want to maintain that we have “the best health care in the world” then it turns out that Canada’s is probably slightly better, almost certainly no worse, and definitely cheaper.
51 Responses to “The Not-So-Awful Truth About Canadian Health Outcomes”
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June 10th, 2009 at 10:47 am
How can a poor man stand such times and live?
Most personal bankruptcies are due to medical bills. The cost of medical care bankrupted the auto industry.
If by magic we could snap our fingers and put a single payer system in here, in a month the public would lynch a politician who suggested going back to the old way.
June 10th, 2009 at 10:54 am
If you ask me, health care in the United States is not so great, so Canadian health care—which turns out to be of similar quality—is not so great either.
How can Matt reach this conclusion if he read what he quotes in his own post?
Since there are about 45 millions of Americans lacking health insurance, many of them probably never get the chance to become a “patient”. So for the sick in general, Canadian health care seems much better in light of this study.
June 10th, 2009 at 10:58 am
Am I missing something? Isn’t this a study of “patients treated”? Why does Matt’s comparison neglect the fact that treatment is available to everyone in Canada because everyone is insured? Also, does he really mean to say that outcomes for those who receive treatment are not that great in the US and so not that great in Canada? Where are the outsomes for those who receive treatment radically better? Sorry for the tone, but as an American living in Canada for the last 20 years, it is very frustrating to watch progressives tie themselves up in knots when Canada’s system actually is that great! Look no further. Single payer is the way.
June 10th, 2009 at 11:00 am
But most important: the canadian system takes care of each and every citizen, regardless of income. How should one qualifie a country that does not look after the basic health needs of it’s people? That’s one way to compare.
June 10th, 2009 at 11:06 am
Agree with the comments above. On the flip side, though, lessening of mortality is not the only metric. There are quality-of-life issues to consider as well. For example, if you have severe back pain and have to wait months to see a doctor about it, that wouldn’t show up in any mortality comparison but does, I think, have some bearing on how well the medical system is functioning. And by the way, I’m not suggesting that the claims of waiting times in Canada are true, I’m just pointing out that there are other metrics that need to be considered.
June 10th, 2009 at 11:06 am
This is Bad Post. As others have pointed out, the problem with American health care isn’t treatment outcomes- the US has some of the best doctors and the best hospitals in the world. The problem is that the people who need treatment don’t get it, and it’s really expensive, neither of which are addressed by looking at treatment outcomes. To malign the Canadian healthcare system in this way because treatment outcomes are only slightly better than in the US is both ignorant and insulting to health care professionals in both countries.
June 10th, 2009 at 11:13 am
Random question: when studies like this do cost comparisons between the U.S. and different countries, is the fact that Americans are fatter, lazier, and generally unhealthier taken into account? That is, isn’t part of our huge cost problem the fact that people don’t take care of themselves (things like publicly provided preventive care would go a long way here)?
There’s been an argument for a long time (I think maybe from Paul Krugman?) that the reason we don’t have better social services is because southern conservatives have used the safety net as a proxy battle over race: “we can’t give THOSE PEOPLE healthcare,” etc. I think I might be a victim of the liberal flip-side of that, where I don’t want to subsidize the obese white family down the street who hasn’t gone for a walk in 10 years together but who just bought a new SUV and flat-screen TV.
June 10th, 2009 at 11:15 am
Most of the commenters missed the point of Matt’s post. The question he raised is whether the quality of care in the Canadian health care system is good. To ask the question you should compare people who are treated in both systems, and dropping untreated people proper. The question “which health care system serves the citizens better?” is a separate question. In the issue of quality of care, the study seems limited but sound.
June 10th, 2009 at 11:21 am
Gee Matty, will you also give up all the American Nobels in medicine and all the associated medical research and all the associated drug research NONE OF WHICH CANADA CONTRIBUTES TO THE WORLD?
What’s that word that you love to deploy to reinforce your half assed prejudices?
Oh yeah, EXTERNALITIES!
And Claude St-Jean’s “How should one qualifie (sic) a country that does not look after the basic health needs of it’s people?” is just more of the same.
How should one qualify a country that contributes NOTHING to world wide medical progress but simply leaches off the investments of it’s neighbor to the south?
Gee, the only Americans I know of flocking to Canada for health care are those looking to save on subsidized-by-Americans drugs.
Instead of Canadians preaching about how grrrreat their nationalized rationing of health care is why don’t they start paying their fare share of drug development costs? Huh?
And by the way, you might also ask Canada’s Native American populations just how great Canada’s health care system is for them. You’ll get quite a different answer than from the pampered poodles of Toronto.
June 10th, 2009 at 11:26 am
If Oprah would put Matt, and a few other good explainers, onto prime time TV for an hour, I think they could slam dunk health care reform.
June 10th, 2009 at 11:32 am
JT, I will leave it to others to dig out the facts on what Canadian scientists contribute to medical research, and just point out your stupid reference to “Canada’s Native American populations”. Perhaps you got this mixed up because we all live on the continent of North America, but up here we have “indigenous people” or “first nations members”. All the “native Americans” live in the US. Piss off.
June 10th, 2009 at 11:39 am
JT is too stupid to know that Nobel prizes go to BASIC research, which is normally government supported and is an entirely different line of work from drug discovery.
June 10th, 2009 at 11:42 am
I’m pretty sure we gave you guys penecilin and insulin. Not sure about anything else, but I’m sure there are more. But those two are like super drugs, so even if that was it, there should be no complaints!
June 10th, 2009 at 11:44 am
JT’s point about drug and medical research might be fair with respect to the question of whether US healthcare should look more like Canada’s. I’m not sure. But it pretty clearly doesn’t bear on the point of MY’s post, which this: patients who receive healthcare in Canada get care that is no worse, and maybe a little better, than the care received by patients in the US.
I have a couple questions about MY’s post. (1) a worry about the canadian healthcare system you hear a lot is that people wait for care more than they do in the US. If that’s true, it would mean that even if the benefits of healthcare are the same in the US and Canada, the benefits come quicker in the US–which is a good thing. If there is a difference between wait-times for care in the US and Canada, that difference wouldn’t show up in the study. Right? (2) I think I’ve heard that Americans are less healthy than Canadians. If that’s true, you might expect that, other things being equal, Canadians would respond better to treatment for a particular illness than would Americans. (Doesn’t a generally healthy person have a better shot at responding well to chemotherapy than does a generally unhealthy person? I assume so, but I don’t know.) If this is right, that might suggest that equal outcomes of treatment in the US and in Canada would mean that the treatment received in the US is better than in Canada–since the treatment in the US makes up for the general-health handicap in the US. Does that seem plausible at all?
June 10th, 2009 at 11:48 am
I think I’ve heard that Americans are less healthy than Canadians. If that’s true, you might expect that, other things being equal, Canadians would respond better to treatment for a particular illness than would Americans.
Not necessarily. That proposition, if true, could also be true for some combination of the following reasons: 1) uninsured Americans drag down our mean state of health; 2) Canada has better preventive care. In which case your conclusion doesn’t follow.
June 10th, 2009 at 11:49 am
Y,
the wait times canard is mostly a product of an overactive imagination. There are no serious wait times for time-sensitive or urgent (let alone life-saving) surgery, only for elective procedures such as hip replacements.
As for your other point, you could also flip it on its head. Because only insured Americans were included in the study, they would have been disproportionately drawn from better-off demographic segments, and excluding the poor and the uninsurable.
June 10th, 2009 at 11:51 am
JT, that would certainly be news Frederick Banting, who won the nobel prize for discovering insulin, and david hubel, who won for mapping the visual cortex, as well as the 8 other Nobels that canadians have won in other scientific fields. I think its safe to say that canada punches well above its weight when it comes to basic research.
June 10th, 2009 at 11:59 am
JT, the reason drugs cost so much in the US is not R&D. The drug companies spend almost twice as much on advertising as they do on R&D. And, the decisions they make on which drugs to produce are driven by what’s most profitable, not what is most necessary. The R&D money they do spend goes towards new drugs for problems that there are already effective drugs for.
June 10th, 2009 at 12:00 pm
I have posted links to this web site before but here’ an analysis by newly minted Dr. Hoofnagel of the denialist web site of the Canadian, British, and New Zealand health plans.
http://scienceblogs.com/denialism/2009/05/what_is_health_care_like_in_th.php
June 10th, 2009 at 12:09 pm
@ Ryan 2:
It’s a more generalized phenomenon — the more racially and ethnically homogeneous a country, the greater the support for social provision generally, and transfer payments in particular.
Alesina, Glaeser and Sacerdote, Why Doesn’t the US Have a European-Style Welfare State is a place to start, at least for the OECD. There’s some World Bank stuff on Malaysia that I can’t find right now, too.
June 10th, 2009 at 12:14 pm
(1) a worry about the canadian healthcare system you hear a lot is that people wait for care more than they do in the US. If that’s true,
It’s not true.
For one thing, in a comparison of waiting times studies never factor in the effective waiting time of the 45 million Americans who have no health insurance and thus never get treated, which makes their wait time effectively infinity. US wait time statistics are artificially made to look better because they only count those who actually become patients and exclude those who never get care (kind of like saying that all Americans are over six feet tall if you exclude those under six feet tall), whereas Canada covers everybody.
June 10th, 2009 at 12:16 pm
(2) I think I’ve heard that Americans are less healthy than Canadians. If that’s true, you might expect that, other things being equal, Canadians would respond better to treatment for a particular illness than would Americans.
The reason Americans are less healthy than Canadians is specifically because all Canadians receive health care, whereas many Americans don’t. You’re reversing cause and effect.
June 10th, 2009 at 12:20 pm
Ah yes, this must be why racially and ethnically homogeneous Canada has a single-payer health care system.
June 10th, 2009 at 12:23 pm
nd:
i wonder how the health of the canadanians-in-general compares to the health of americans with health insurance. it doesn’t seem obvious to me one way or the other. i couldn’t figure out from a quick google search.
i don’t if people do wait more in canada than in the us. i’ve heard that canadians don’t wait for time-sensitive treatments. but waiting for for time-insensitive treatments is bad too, though obviously not as bad as waiting for time-sensitive treatments. waiting for time-insensitive treatments would mean you spend more time sick, even if in the end you get just as well as you would in the US.
(To be clear, I think these are basically academic questions. The big problem in the US is obviously the number of uninsured folks. To me, it’s a no-brainer that any advantage in quality of care there might be in the US fails to make up for the problem of huge numbers of uninsured people.)
To steve labonne, i think it’s really likely that folks lacking insurance has a significant negative impact on the health of americans. But i think it’s also pretty clear that the bad health of americans also comes from lifestyle stuff, like what we eat, how much we exercise, maybe how many hours we work (stress).
June 10th, 2009 at 12:44 pm
I want to bring attention to the two most obvious benefits of the Canadian single-payer system, since they fall a little out of the scope of this post.
The first is that not only is health care cheaper in Canada in the aggregate it’s also no financial risk to individuals. Americans with employer-based private health insurance tend to feel good about their coverage, studies say. Of course even those people that have and are satisfied with such plans are living with significant personal financial risk. There’s the constant risk a serious diagnosis or accident could easily put them on a path to a treatment isn’t covered by their plan (where costs are rising for employers and employees both, along with pressure to cut benefits, I assume.)
Worse yet, even if you have good insurance and your condition is technically covered you’re up against an insurance industry whose profit-margin relies on paying you as little as possible, with a large workforce dedicated to ensuring exactly that. And, since employers generally choose the health plan—not individuals—there’s little chance that your insurance company’s decision to deny you payment will cause any sort of financial pain for them. Isn’t that what Sicko was about? I never watched it. I didn’t need to; I’m Canadian.
That is an ever present financial risk hanging over the heads of even healthy insured Americans. I can’t imagine what it must be like, but they say you can get used to anything.
Second, Americans are systemically unable to have a serious, productive public debate about health care—at least not like Canadians do. Say what you want about the quality of Canadian health care, but keep in mind it’s the product of 45 years of provincial and federal elections in which the quality of health care has been heavily debated by both politicians and experts as a top election issue. If there were democratic will to change it, we could and would. You can’t say the same for yourselves, the hurdles are far higher.
Each Canadian election cycle sees the generation of a serious health care platform by all major parties addressing systemic problems, balancing costs with service quailty and wait-times. We elect one party (or a minority), and they give their ideas (or compromises) a shot. If we don’t like the resulting policy, it makes a big difference to a parties electoral fortunes. In 2004, shortly after being elected, the current Ontario government raised taxes (sorry, “health premiums”) to pay for improved quality of care and shorter wait times. In 2007, when they were up for re-election, it was a major election issue.
We re-elected that government, but at least we got to vote on it. Our choice between quality of care and cost was exactly that our choice, just as it should be. I can’t imagine a world where those decisions are made any other way.
June 10th, 2009 at 12:48 pm
Stefan: the important point is the one you’re making. basically that it’s terrible that tons of americans are uninsured, and we ignore that at our peril. but I think MY’s post was concentrating on how US-healthcare-in-action compares to Canadian-healthcare-in-action. The important point that lots of commenters are bringing up is that for too many people, US healthcare is not in action, so to speak. Too many people aren’t insured. But if you’re concentrating on US-healthcare-in-action, then the “wait times” of people who are uninsured are irrelevant–with respect to *that specific question*.
June 10th, 2009 at 12:52 pm
Oh, and to the commenter who claimed that Canada doesn’t contribute nobel prizes to the world: the insulin treatment for diabetes was developed by Banting and Best at the very hospital pictured in this post. (Okay, not exactly that hospital, Toronto General has been rebuilt since but the institution is the same.) I think there may be a few Americans using that treatment.
That was a sloppy off-the-top-of-the-head claim if I ever heard one.
June 10th, 2009 at 1:15 pm
But it could only happen if customers were to show a consistent and overwhelming preference for the public plan, in which case the public plan coming to dominate probably wouldn’t be such a bad thing.
I pretty much agree with the gist of Matt’s post. However, conservative opponents of major reform with public option will correctly point out that in most cases “customers” is likely to mean “employers” and “overwhelming preference” may simply mean “they find it cheaper to pay stop buying insurance and pay the tax.” Just pointing this out in the interests in being prepared for their arguments. I think being on the fast track to Canada-care would be a huge net improvement for the United States. I also suspect conservatives are correct, though, when they say a robust public option will, in fact, put us on the slippery slope to Canada-care (or, more likely Franco-care).
June 10th, 2009 at 1:19 pm
When discussing “wait times” it is also important to keep in mind that patients go through triage and wait times will depend on their “need”. For example, my father fell and broke his hip on Sunday morning, was taken to emergency, admitted the same day, and operated on two days later. He was home and recovering a week after that, with a brand new hip. Free of charge.
Elective surgeries and non-critical operations will necessarily have longer wait times. Plus you have to eat “hospital food” instead of being able to order off a menu.
The question that should be asked is: do you want to wait an extra two weeks, or do you want to go bankrupt?
June 10th, 2009 at 1:21 pm
I’m sorry to re-post, but my previous submission appears to be germane to this issue:
June 10th, 2009 at 1:22 pm
The claims about waiting times in Canada always amaze me. For one, every Canadian friend I have says waiting times are grossly exaggerated by single-payer opponents, and I have yet to meet a Canadian who wants to scrap their system in favor of one like ours.
Waiting times are just as prevalent, if not more so, in the U.S. In some cases, average waits here are longer than in Canada. Just try to schedule a mammogram or pap smear – especially with a gynecologist you are not a long-time patient of. I’ve seen people have to wait months, even half a year and longer in the U.S. to get an appointment for exams that could affect their lives.
Also, when switching jobs here, many people find they have to wait up to three months before being included in the new insurance, and anything the private insurance company can twist into a “pre-existing condition” in many states means no coverage for the illness for 12 months. A friend of ours tested positive for the BRCA1 gene mutation that increases risk of both breast and ovarian cancer before getting her most recent insurance. Subsequently, she was diagnosed with breast cancer and the insurance company refused to pay for any treatment, citing the gene mutation as evidence of a pre-existing condition. She is now deep in debt, filing for bankruptcy, and has had to skip numerous treatments and tests she just can’t afford. Her likelihood of survival is not very great because of this.
Then add in all of the procedures where there’s no waiting period because some bureaucrat in your HMO or PPO won’t even authorize payment for a test or exam and you are simply denied the coverage for arbitrary reasons.
Canadians don’t have to worry that their premiums, deductables, and copays are always rising, while their services are declining.
Factor that by the fact that the United States has a much higher GDP per citizen than Canada, and, for the same percentage of GDP can provide single-payer insurance that is far better than Canada can afford – at least the equal of the best systems in the world, such as France’s, Norway’s and Denmark’s (countries with lifespans at least 3 years longer than ours – and in some cases 5 and 6 years longer). Canada ranks 8th in life expectancy in the CIA’s World Factbook, while the United States ranks 50th, marginally ahead of Angola.
Now add in the fact that no Canadian (or citizen of ANY other advanced country) lives with the day-to-day anxiety and stress of being uninsured or underinsured; that losing a job doesn’t cost them their health care; that catastrophic illness can’t destroy them financially; that it is their doctor and not some bookkeeper concerned only about the profit margin who is making their treatement decisions. That alone should put the Canadian system far above ours.
Everybody who has insurance pays for it one way or another. Employer-based insurance is simply a hidden tax that is taken out by your employer before you even see the gross (in addition to your deductions, copays, etc). So, in oversimplification, if your employer can afford to pay a particular job category $75,000 and must pay $10,000 for its end of your health insurance benefit, it will quote you a salary of $65,000. You’ve already paid a “tax” of $10,000 that could have otherwise gone into higher salary.
One major difference between this private system and the Canadian single-payer system are that a major portion of what Americans pay (including the hidden portion) goes to stockholders, executives, overly bureaucratic administrations, and the half-trillion that the industry pays out each year to lobby against single-payer. While, the single-payer systems put only several percent toward administration and way over 90% goes to actual health care. Medicare, for example, averages around 2% for admin, while private companies typically average 15% to over 30% just for administration (and that doesn’t include dividends, bloated executive salaries, and lobbying).
June 10th, 2009 at 1:30 pm
Jesus, Mary and Joseph. Somebody should be held criminally liable for this. That’s one of the most appalling care-denial stories I’ve heard, and I’ve heard some pretty awful ones.
June 10th, 2009 at 1:45 pm
The insurance business in every industry is lousy:
Most people I know don’t bother putting in claims on their cars unless the thing is totaled…it’s not worth the ramifications (increased premiums or loss of coverage).
I’ve never met anyone who has had any kind of water damage claim paid out by their homeowner’s insurance, and forget about flood insurance in many parts of the country. Guess what one of the most common problems occur with a house?
If you’ve got any kind of health problem, you better have a lot of money because you’re either going to be denied, or your premiums will be unbelievably expensive.
Sometimes I get so frustrated feel like getting rid of all my insurance. I should be okay unless I total my car, my house burns down, or I come down with cancer.
June 10th, 2009 at 1:50 pm
Regarding JT’s comment that Canada “contributes NOTHING to world wide medical progress,” I suggest that he do some research of his own. A good starting point would be a 2006 FASEB J article that ranked countries by their annual contribution to the top 50 biomedical journals (FASEB J, 20: 29-34, 2006). While the US ranked first, Canada came in second, ahead of Europe, Japan, Australia and the rest of the world. When you consider that Canada spends much less per capita on biomedical research than the US, Canadian researchers look even better.
June 10th, 2009 at 2:13 pm
Stefan: the important point is the one you’re making. basically that it’s terrible that tons of americans are uninsured, and we ignore that at our peril. but I think MY’s post was concentrating on how US-healthcare-in-action compares to Canadian-healthcare-in-action. The important point that lots of commenters are bringing up is that for too many people, US healthcare is not in action, so to speak. Too many people aren’t insured. But if you’re concentrating on US-healthcare-in-action, then the “wait times” of people who are uninsured are irrelevant–with respect to *that specific question*.
No, they’re not irrelevant, because otherwise the comparison is between the Canadian sample (100% of the population) and the American sample (85% of the population), which results in an apples to oranges problem.
Basically, by comparing only US healthcare-in-action against Canadian healthcare-in-action, you allow the US to get the statistical advantage of excluding its poorest and sickest, while the Canadian statistics are artificially skewed downwards because they have to include the entirety of the population.
June 10th, 2009 at 2:20 pm
Why is Canada currently moving away from its current health-care system and moving quickly to a two-tier system?
Why is private care within Canada doubling every year?
Why do Canadians have a 35% tax rate?
June 10th, 2009 at 2:20 pm
I’ve never met anyone who has had any kind of water damage claim paid out by their homeowner’s insurance
The ice maker on our fridge malfunctioned and the overflow ruined the linoleum. Our homeowners coverage paid promptly for the new floor.
June 10th, 2009 at 3:51 pm
Actually, American health care generally sucks. It is highly fragmented such that people routinely fall through the cracks and fail to get required follow up, doctors often don’t know the total number let alone the type of drugs an individual patient is taking, leading to complications and adverse reactions that make the patient’s condition worse, not better. People are routinely subjected to unnecessary tests that sometimes have the risk of false positives and thus unnecessary treatment, not to mention side effects from the test or the treatment. A person might be shunted around to 5 or 6 different doctors and not a single one of them will look an inch beyond their own specialty to figure out what might be wrong. Doctors are frequently financially conflicted such that you can’t even be sure your welfare is uppermost in their consciousness.
It’s actually pretty poor, and it’s nearly insufferable if you aren’t sufficiently well educated to challenge doctors on their questionable practices.
June 10th, 2009 at 4:10 pm
Why do Canadians have a 35% tax rate?
Why do you spout bullshit? I’m a small business owner in Ontario (Gasp! The socialist government hates me!), earned over 56K last year, including investment income, and after taking off some tax credits for retirement and charitable contributions, my effective tax rate was about 26%. Part of that covered my excellent health care.
If I earned a lot less, say 25K, my effective tax rate would be closer to 12%. This would also cover my excellent health care.
And if I couldn’t work, or if my income was under 12K, I would pay no income tax and would still enjoy excellent health care.
I like this country. I think I’ll keep working and living here.
June 10th, 2009 at 4:35 pm
I like this country. I think I’ll keep working and living here.
Yes, but you haven’t invaded anyone lately, so you don’t get to feel all manly and macho via proxy. That’s a small price to pay for being bankrupted by medical and educational expenses.
June 10th, 2009 at 4:53 pm
The US is probably the only developed nation where the fear of getting sick can make you sick.
June 10th, 2009 at 5:45 pm
Barbara @38: Amen.
Were I not always on the Google reading about my various health conditions, I’d be very sick indeed. For the most part, my doctors write prescriptions for my chronic illnesses. If I actually had to rely on them for treatment, I’d be screwed.
They are decent people, I think. But they aren’t well-paid by the HMO, and they triple-book to make money. I have 5 minutes to make my case. I always write everything out at home and hand them a report on my condition.
All I hear from my Scandinavian partner when she sees the medical care I get and the medical infrastructure I deal with (things like Urgent Care and ERs) is that the US clearly is a third-world country.
June 10th, 2009 at 6:58 pm
Re: Am I missing something? Isn’t this a study of “patients treated”? Why does Matt’s comparison neglect the fact that treatment is available to everyone in Canada because everyone is insured?
Treatment is available to everyone in the US as well. But the uninsured generally end up with massive bills they cannot pay. Eventually (I am assuming they have some chronic health condition) they end up on either Medicare or Medicaid or some state “medically needy” program. However the delays involved in getting to solid coverage are often much longer in duration than any of those infamous waits for care in Canada and in the meantime their situation can worsen a lot.
Re: The problem is that the people who need treatment don’t get it,
That’s a gross exaggeration. Most people who need care in the US do get it. Only a minority is uninsured after all. To be sure I agree that any uninsured is unacceptable, but hyperbole is not called for.
Re: is the fact that Americans are fatter, lazier, and generally unhealthier taken into account?
Are you sure this is a “fact”? Obesity is a worldwide problem. Visit Torointo sometime, and go off the beaten path where the young and beautiful hang out. You’ll see lots of fat Canadians too (their diet is indistinguishable from ours). Moroever there are a number of countries where smoking and heavy drinking rates are higher than in the US. We may be close to the top in fatsos, but we are no where near there in drunks and chimney-like smokers.
Re: the constant risk a serious diagnosis or accident could easily put them on a path to a treatment isn’t covered by their plan
The issue isn’t so much treatments that aren’t covered: any decent health plan will cover any and all standard treatments. The problem is more the escalation of copays (and sometimes deductibles) so that many people have far more exposure to high out-of-pocket costs than they realize.
Re: even if you have good insurance and your condition is technically covered you’re up against an insurance industry whose profit-margin relies on paying you as little as possible, with a large workforce dedicated to ensuring exactly that.
Health insurers generally pay healthcare providers, not the insured. And it’s usually the doctors and hospitals that take the hit when the insurer uses their many arcane contract details to discount their payouts (Look at an EOB sometime).
Re: the private insurance company can twist into a “pre-existing condition” in many states means no coverage for the illness for 12 months.
That’s illegal, if you were covered at your previous job. As long as you have no more than 62 days between coverage your new insurance MUST cover you for anything the old insurance did. And if your new coverage doesn’t start for 90 days, then for crying out loud pay COBRA for a month (I did that once in this situation, so I am not giving advice I have not or would not follow)
Re: Subsequently, she was diagnosed with breast cancer and the insurance company refused to pay for any treatment, citing the gene mutation as evidence of a pre-existing condition.
Sid your friend appeal this to her state’s insurance regulatory body? She should have. Insurance companies that try to pull stunts like that will generally have the book thrown at them, even in “red” states. (Since people in your freind’s situation will otherwise end up on public, state-paid plans like Medicaid, most states are strongly biased toward keeping people on private insurance in these sorts of disputes)
June 10th, 2009 at 10:01 pm
I live in Canada, too. The health care’s great. You guys don’t know what you’re missing.
June 11th, 2009 at 3:30 am
The “waiting times” thing always amused me, coming from US critics where the system shuts out 40-odd million people (whether through ignorance of benefits available or by inability to pay), encourages millions more to self-select themselves out of taking advantage of medical treatment by such niceties as high deductibles (strangely, most conservatives seem to find this a good thing, in spite of the hell it raises with preventive medicine), and then probably under-insures even more, considering that out of the 60% of bankruptcies that were medical-related, more than 75% of the people in question had health insurance at the outset.
They’re not. Before you cite the Quebec Court case, keep in mind that the Court, in its judgment, explicitly recognized the importance of maintaining the single-payer system.
How delightfully vague – and typical, for a probably-American critic. The vast majority of health care providers in Canada are private, for-profit doctors and/or groups, and have always been as such. There’s been no significant movement away from the single-payer universal insurance system either.
This is a deception I’ve seen before, used by dishonest folks like David Gratzer of the Manhatten Institute. They post statistics of the growth in private clinics, then act as if this is somehow undermining the Canadian health care system – more or less counting on the fact that most Americans know fuck-all about Canadian single-payer and probably assume that all the doctors are part of a socialized, big-government bureaucracy.
That probably happens to a significant number of the insured as well once they get a costly medical condition. As I mentioned above, there have been studies pointing out that around 50-60% of bankruptcies every year are driven by medical costs, and three-quarters of those filers had health insurance at the time when they started to incur those costs.
The sad thing is, this seems to receive very little traction in the current debate, when one would thing something like this would be a bombshell – it’s a stake directly in the heart of the idea that the current system is anything resembling “secure” for Americans with health insurance.
June 11th, 2009 at 3:54 am
The United States is number 1!
In obesity. 30.6 percent of our population is considered obese. Canada is pretty fat, coming in number eleven on the world obesity list, at 14.3 percent.
The United States is number 1!
In bankruptcies, and 62 percent of American bankruptcies in 2007 were health care related. Being insured doesn’t help much. 78 percent of the filers were insured.
The United States is number 50!
In life expectancy.
The United States is number 35!
In infant mortality.
The United States is number 1!
In spending on health care. Americans spend $5267 per capita. The next closest country is Switzerland at $3446 per citizen.
The United States is number 35!
In overall world health care ranking.
The Unites States is number 1 in history!
In providing the worst overall health care ever, relative to time period and wealth status.
June 11th, 2009 at 4:06 am
How do we fight for single payer if big pharma and the insurance companies have so much more money and pull in D.C.?
They have Republicans spouting their anti-Canadian single payer talking points all over the place.
My own parents are starting to believe their crap, and I am their 38 year old daughter who had cancer a few years ago and now cannot get “any” health insurance or afford out of pocket costs. My parents have a good example right in front of them of how the system is screwed up and leaves people in massive debt and facing financial ruin, and yet as soon as Sean Hannity or a Republican mentions wait times and rationing and socialism suddenly they aren’t so sure about this single payer thing anymore, and they just reached Medicare ages. It’s hard to fight when even your seemingly closest allies get sucked into their talking points. It’s going to be a long battle, I just hope I live to see the outcome.
June 11th, 2009 at 7:57 am
Try living here
Its a matter of graphs and charts by the bureaucrats regardless of reality
It all comes down to the cancer of bureaucracy
The only thing that increases is their departments and the amount of fancy new buildings
June 11th, 2009 at 2:06 pm
Canadian health care is NOT FREE! It is funded mostly by taxes. MOST Canadians pay an annual health care premium that averages several hundred dollars per month, through these taxes. Low income families and those on government assistance are exempted. There is also a long list of out-of-pocket expenses that have to be paid for certain procedures/treatments/surgeries that are not covered by government health care.
There ARE long waiting lists for treatment in Canada, with the exeption of life-threatening situations. There is an alarming number of people that are suffering daily with moderate to severe chronic pain, which will only balloon as the population ages. Doctors and hospitals are not allowed to provide private care for anything that is covered by government health care (which increasingly covers less and less). You could wait many hours in an emergency room for treatment. Unless your problem is life-threatening you’ll not get the attention of those who are have more serious problems. Those families that do not have a family physician end up going to the local hospital and sitting in the emergency room, if no walk-in clinics are available.
There is less and less ‘medical curiousity’. Perhaps due to too many patients and too few doctors, but too many people are being given pills and sent on their merry way by physicians that have thrown in the towel instead of trying to find out what ails their patient. If it’s not easy to diagnose, they don’t bother and go on to the next patient. A new policy the health care system is pushing these days to their patients is “Be responsible for your health care”. That says it all right there.
Too many hospitals are busy worrying about their public image. Ever notice how many times a hospital’s logo will change? Imagine the tax dollars hospitals used to tweak a slogan, change a logo, change identity colours, and to employ the ‘necessary’ staff to do so. Shiny and pretty doesn’t heal people. Less money should go towards image care and more into patient care.
June 11th, 2009 at 2:29 pm
DJ,
I will take paying several hundred dollars over the quote I usually get which is around $1200 per month any day. I will take being on a waiting list for routine elective procedures as opposed to having to pay out of pocket any day. I will take not being afraid of financial ruin and facing bankruptcy just to get cancer treatment any day. Your scare tactics don’t work with me at all. These are the usual talking points Frank Luntz and others are weaving into the day to day American health care debate, and clearly they are working. The opposing side will dig up the few Canadians who have “scary” stories and plaster them all over the place. Clearly these stories are working on my friends and family and I am feeling increasingly alone in my quest just to get some damn health care.
June 11th, 2009 at 10:05 pm
DJ, you are incredibly full of shit.
Yes, we pay taxes to fund health care, because TANSTAAFL, FFS. But those taxes are nowhere near several hundred dollars per month unless you’re paying thousands of dollars a month in taxes (which makes you pretty freaking rich). Did you see my estimate of total taxes, covering EVERYTHING, both federal and provincial, at comment #39? My 2008 TOTAL income taxes per month were a little over $1100 on a solidly middle class taxable income. If I earned $25,000 a year, my monthly income taxes would be closer to $250 a month.
Waiting lists vary. There are waits for things like hip replacements, and other medical areas have some lists that wax and wane from province to province, but to say that the only thing we don’t wait for are life-saving surgeries is a complete lie.
Jesus. Read this.