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In his post, The Not So Awful Truth About Canadian Health Outcomes, Matthew Yglesias comments on a study done in 2007 which systematically reviewed studies to compare the health results for patients achieved by the US and Canadian health systems. The study he refers to, by multiple authors, is here. Yglesias summarizes key findings and then takes the Study authors’ conclusion,
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.
. . . and draws his own conclusion:
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.
It’s a good point, but I wonder if there’s more here. I could be misreading the original study, but what the study seems to be doing is comparing the health outcomes of patients once they get into the system and actually received treatment. The study is asking, "How did the actual health outcomes of patients compare in the two systems, once they were treated by the system?" So to be considered on the US side of the equation, you had to get into the system in the first place, then get treated. Everyone is automatically in the Canadian system.
In other words, the study doesn’t attempt or claim to deal with the fact that tens of millions of people are excluded from the US system or discouraged from using the US system because they can’t afford to pay for treatment and their insurance provider refuses to cover them at all or cover their treatment.
Once you take those differences into account, the US system isn’t even remotely comparable in overall "health outcomes" to the Canadian system when you consider the whole population. It’s an embarrassing disgrace. Am I misreading that report?
Update: Commenter bluebutterfly drives home a critical point: "The US has more citizens without health care coverage than Canada has total citizens."
More:
Ezra Klein dismantles the Wall Street Journal editorial against health care reform.
Ryan Grimm/HuffPo has links to the Kennedy/HELP Committee draft bill
Canadian debunks Canadian health care myths
29 Comments
The automatic “in”–I can’t wait until that happens here. Thank you for this post.
Oh we heard all about this from the so-called Canadian X-pert during the House committee hearing on Examining the Single Payer Health Care Option. The testifier david gratzer talked up some mighty cant. Hopefully selise will have some clips soon.
Our X-pert witness might say you are quibbling over small details.
I went back to check on something in Yglesias’ post and noticed that several commenters were already raising the point I make here, with some criticizing Yglesias for overlooking this. I don’t agree with the criticism; I think he was focused on rebutting a simple argument frequently made by our insurance/industry, that treatment in “government run” systems is inherently worse than our “private” system. The study of studies seems to disprove that, and that point, all by itself, is worth making. Then he adds that our system costs a lot more per person.
On top of those valid points, we leave millions not covered at all or cover only partially, forcing many into bankruptcy trying to cover the rest.
The US has more citizens without health care coverage than Canada has total citizens. Canada is large in area and three quarters of Canadians live within 150 miles of the Canada/US border. The other quarter are dispersed across the whole of Canada. That is why the diagnosis time can alter results that can be manipulated to look like people are denied care. Travel to a city to obtain a diagnosis from things such as a MRI or Cat Scan machine is a fact of life. In Canada, health care is a birthright. No co-pays, no deductibles, no limits, no refusals, no pre-existing conditions clauses, and no forced divorces to obtain medical coverage like Mary and Ron. The reason this list exists is because Canada does not allow blood sucking vampires aka insurance companies to run the system. It is that simple. Any article you read that does not contain these facts is nothing more than someone’s attempt to distort people’s view of single payer. It is unfortunate that name was picked. It does not reflect the Canadian system that you want.
Canada has a 50/50 cost sharing system between the Federal government and the Provincial/Territorial governments. The citizens of most provinces,(Manitoba is free), pay a portion of the costs through monthly premiums. It is not a one payer system, or a single payer system. This is the most important fact that single payer advocates must push. Your adversaries are saying the government can’t afford it..not a one of them has mentioned how the Canadian system actually works ie cost sharing between the government and its citizens. I have yet to see an article from an advocate that states clearly how the Canadian system actually works, either.
Thanks for this post. The issue of population coverage for treatment makes many quality comparisons between the US and other developed countries impossibe. Waiting times for care is another example. In the U.S., if you do not have insurance coverage and cannot afford care, what is your waiting time for care? You are not even included in the statistics. This is why good and careful studies do not even include the U.S. (even those done by respectable, but relatively conservative thinktanks -for example, OECD health studies).
I think Bluebutterfly makes an important point -how the Canadian system actually operates is often misrepresented in the U.S. As another example, many funding and planning decisions are made at the provincial level, not the federal level in Canada. So, a cheap provincial government that is not friendly to the social insurance model of health care can do significant damage to quality of care.
Below is a brief description of he provincial role in health care funding and planning from a very good source for descriptive information on health care systems.
I leave it to the reader’s imagination what a similar system would produce for, say, California, over the next two or three years.
The basic point is that no one is proposing a Canadian style system here, I think.
Two further comments,
More from the report referenced above on the provincial role in financing:
Gluttons for punishment can read a much longer report that goes into more detail on division of labor between federal and provincial governments in adminstering and financing health care:
http://www.euro.who.int/Document/E87954.pdf
warning: large pdf file
Second point, I think that the report discussed by Yglesias is important. There is a myth that the U.S. healthcare system provides superior treatment across the board, for everything, even when only considering those who have resources to pay (that is, those treated). But it is doubtful at best. The U.S. probably has best treatment for some acute conditions such as heart attack and is among the best for many cancers. For other conditions, others, such as the UK, seem to provide better treatment -diabetes is an example.
Thanks for the Canadian links.
somewhat related: I notice there was an op-ed in the NYT today about the increasing use by Americans of treatment in other countries — apparently because you can get comparable treatment (though studies are needed here) for much lower costs, even after the figure in the travel expenses.
http://www.nytimes.com/2009/06…..ef=opinion
The fact that provincial governments are not dictated to by the federal is exactly why we have the system we do. Each province is different. Different population numbers and different numbers of doctors, hospitals, labs, clinics etc. The doctors negotiate their fees with the provincial government. The nurses,lab workers, etc. negotiate their fees. The provinces tell the federal government what their 50% share is; not the other way around. The fees paid by the government are negotiated by the providers of the care; not some insurance company that operates for profit and denies and kills people in the process. Our hospitals are publicly owned and operated; not for profit.
Some places have regional boards and some don’t. Many places in Canada are far too small to have a board because there isn’t a health care system to oversee. At the risk of sounding like Cheney, I say “so”? Don’t think that we the people don’t influence the boards we do have. They are needed to oversee where money is spent and to petition the provincial government for more funds when they are needed. There is much to oversee. One thing no board can do is deny doctor or hospital care anytime, anywhere, to anybody. That is a guaranteed right and not one that any board is involved in. Decisions on population make sense when certain factors are considered. The amount given to each hospital during the year is partially based on the services provided. Where I live, we have a regional hospital which means that patients come from hundreds of miles. Our hospital maximum allotment each year, is based on the required number of doctors, operations, and other services provided. It is not based simply on the population of one city. We have a cancer clinic inside our hospital that is, like everything else, 100% paid for. A clinic that by its nature is very expensive and that means we will get more provincial funds than a place of equal size that does not have one.
Do you not want each person to pay one small premium to enable affordable health care coverage for every citizen of the US? We pay on the basis of net income from the previous year. I think that Canadian style health system is exactly what is being advocated for. Your doctors would soon learn some negotiating skills if they were forced to. Cut their intravenous line of endless profits made from contracts with for profit hospitals and see how fast they get on board. Screaming and yelling for sure, but on board they will get.
Thanks for the information. I agree with you that the basic concept of a Canadian system is being debated. I think that advocates of a single payer system have the basic concept of the Canadian system in mind. But I also think that there are very important differences between the U.S. and Canada, and some of the mechanisms of the Canadian system cannot be transfered to the U.S. Particularly financiing. I do not see how a state level financing system could work in the U.S. with the restrictions placed on most state budgets. To transfer all the financing mechanisms of the Canadian system would require changes in public finance that would be very difficult to achive in the U.S.
I also think that some of the unfair (and often untrue) horror stories that purport to represent the problems in the Canadian system are due to provincial level decisions on funding and resource allocation, reflecting the details of the Canadian system that have no relevance to its implementation in the U.S.
From polls I have seen the vast majority of Canadians are relatively satisfied with their system, and I did not intend to criticize it.
Debunking Canadian Health Care Myths
Excellent short list of all the lies that keep floating out about the Canadian health system. Have friends who live there….. would NOT move to the US for the “best health care in the world” ….. that statement is a piece of crap
In Canada, all diagnostic tests for cancer and the subsequent treatment of any cancer that is found, are paid for. I recently had a Cat Scan for exactly that reason. Shortly, I will have a biopsy done. I am under treatment for a previously diagnosed cancer. Cost to me…zero. All doctor visits in relation to the fore mentioned costs me…zero. All doctor visits for any reason throughout the year…zero. All lab tests cost me…zero. All x-rays cost me…zero. The US has some of the best trained doctors in the world. What good does that fact do for all of the millions who cannot access their services?…zero.
I’ve seen a number of comparison posts on blogs, and inevitably, folks from Canada comment and almost universally provide anecdotes like yours. It is depressing how the insurance companies here can get away with such misleading ads.
It is beyond depressing…downright disgusting is what it is.
I’m sitting here with a bill from Mayo for $3600 for this year, I have already paid $1400. I have advanced cancer, mets to brain, lungs, small intestines and left groin lymph nodes. With my insurance I have to pay $4500/year for it to pay at 100%.
Thank you so much for consumerism in health care….. where I need to make wise decisions on what care I receive…. so what do I give up….. the monitoring CT scans to determine the status of my disease? Or the weekly chemo that might keep my disease at bay? Or should I skip the whole brain radiation and just become a burden on society?
(((((((((((((((((((((((((((((((Katymine)))))))))))))))))))))))))))))))
I’m so sorry, so very, very sorry. My thoughts, and prayers if it’s okay, are with you.
Hugs,
Heather
Stories like yours make me furious because it is so wrong what you all go through in the US. Always many billions of dollars for damn weapons and war, but no money for people’s medical needs to be taken care of. I’d sure like the opportunity to speak to a few of your senators. Put me in the same room as Baucus and I guarantee his attitude would get a tune up.
What do you have to pay for at Mayo, Katy? The chemo? I am asking because sometimes drug manufacturers will donate things like that to people who cannot afford it. Have you tried that option if the bags of chemo are what you are paying for? Two years ago, a woman I know (aged 38) had $12,000 worth of chemo supplied by the manufacturer. She wanted a new form of chemo that works best for young women because breast cancer is faster growing in young women. Our medical plan had not yet approved it for use and payment in BC, so she sent a letter to the manufacturer. If you haven’t tried yet, you have nothing to lose by trying now. I wish you the best in your tough battle, Katy. Hugs to you and hugs to your hubby.
My thoughts are with you too, katymine — I admire your resilience and wit very much.
In Ontario our healthcare “premium” is now hidden in provincial tax, so I always have to look up the chart on the tax form to guess at what people are paying. People whose taxable income is less than $20,000 a year pay nothing; above that, arithmetic is required. For anyone who’s interested, the chart appears in Step 7 on p 3 of this form (pdf).
Because I live in a big city very close to a solid mile of specialized hospitals, clinics, and labs, I’ve never had any problems with access, and I’ve been through surgery for what turned out to be cancer. When the surgeon I saw within hours of an ultrasound decided that my case shouldn’t wait, she did some time-trading with another surgeon and bumped me up in the schedule. That was ten years ago. (I’m still knocking on wood, mind.)
My main complaint with our system is over what isn’t covered (I have a private dental plan, eg, but many people don’t), or over our still-clumsy attempts at organizing decent homecare or nursing homes. A lot of people here, I suspect, run on the assumption that such things are also covered by public insurance … until they find themselves caught up with a catastrophic illness like Alzheimer’s, and then they discover that things are … complicated.
A few years ago, I read Eleanor Cooney’s superb book Death in Slow Motion, which eventually becomes a recounting of how she coped with her mother’s last illness but is also a genuine literary achievement and a terrific read. Cooney’s account, late in the book, of what she had to do to find a decent nursing home for her mother in California was simply hair-raising to me. I’m an Alzheimer’s widow, and I thought that what I’d gone through coping with the Ontario bureaucracy was rough, but no one should have to face the bizarreries and expense that Cooney — and of course her mother — did, for far too long a time.
thanks for the link.
Every time I see/hear Shelby says the US health care system in the world I explode inside with disgust, wondering how in the world he could be so incredibly stupid. And then there’s the idiot Hatch and company. They are all so unbelievable. So appreciate the comments on the Canadian system; I’ve longed to have some particulars in hand.
Scarecrow, Thanks for keeping us informed and giving us a framework of analyzing the evolving actions.
Blessings to all,
Well, OK, I can see how this was a bad sentence
“The basic point is that no one is proposing a Canadian style system here, I think.”
I should have said
“No one is proposing to transfer the Canadian system in its entirety to the U.S. with no changes needed to accomodate differences between the countries”
But one criticism I do have of the Canadian system is that I think that there can be too much short term political interference in funding and resource allocation decisions at the provincial level. I think that is a legitimate criticism. Other countries have a similar system. Sweden for example has a lot of regional autonomy. I understand that there are great benefits to regional variation in the the design of a national healthcare system, but every system on earth has flaws. I think, for example, Albeeta and Quebec, have produced some problems in health care delivery due to political meddling at the provincial level recently, due more to political motives than anything else. But I will have to go reread the sources -I might be wrong about which provinces have meddled recently.
Alberta keeps on trying to follow the US model..and gets blasted by the people and the federal government that reminds them there are rules in place to prevent that. Alberta is an oil province and has some politicians who would really like the corporations to have all the money they can gouge out of people. Quebec, I don’t know about and am too lazy to look tonight. Suffice to say, it could be them. They have been trying to separate from Canada for years, so nothing they do would surprise me. BC’s government is rather US neocon like. They broke some union health care worker’s contracts a couple of years ago. It took some court action, but the government got a good smack down. I think they had some lawyers who trained under Gonzales, or someone similar..’g’. They blatantly pulled off an illegal manoeuvrer in plain sight and for some unknown reason, actually thought they could get away with it. Any politician that tries to take away our health care is a fool, or has a death wish, or both.
As another Canadian, with multiple disabilities due to being born with Turner’s Syndrome, let me give you a view into my medical world.
About three weeks ago I started with a new doctor, because my former doctor moved back to New Zealand to start her family. This new doc sent me for a bone scan, to see if I had any sign of osteoporosus. Cost for the visit to my regular doc= $0. She works in a Walk-in Clinic, so I saw here the same day I made the appointment. I walked in at about 11am to make the appointment and it was made for 12:30. Between the two times, I went and completed other errands.
The scheduler for the hospital where I was getting the scan called me later that week and scheduled the scan for early the next week. I went and had it done, was in and out in about an hour. Cost for the scan = $0. It took a week for the scan to be read and the results sent to my doc.
Once my doc had the results, they phoned and scheduled an appointment to give me the results, for this last Monday, because my particular doctor is in the clinic on Mondays and Tuesdays. I’m free to see any of the other doctors that work there if I like.
On Monday, she told me that I definitely have osteoporosus in my spine and gave me a prescription good for three months worth of the medication she wants me on, renewable for a year, at the end of which she will have another scan done to see how my spine is doing and whether I need a more powerful medication. Cost out of my pocket for the medication = $9 for a three month supply, and that included a pill minder so I know whether I’ve taken it.
I live in BC, so we do have monthly premiums, which are $50 a month, unless your income is below $25,000 a year, in which case it is either half that, or free if it’s under a certain number. I’m a “starving student”, so my premiums are free. As part of my student fees, I pay a yearly $250.00 fee for extended medical benefits, which pay 80% of dental and vision and prescription costs. If a British Columbian’s prescriptions are over $500 for the year, any amount over that is completely covered.
Just a basis for comparison,
Hope this helps,
Hugs,
Heather
Terrific. I’d like to use this in a future post. Would you permit that?
“the study seems to be doing is comparing the health outcomes of patients once they get into the system and actually received treatment.”
A fair point. But the study was clearly meant to address the usual big pharma/insurance-company screed, which is allegedly inferior quality, not accessibility.
This study is important because it shows that, when you head to head with them on their own terms, they still lose. The usual industry tactics–fear-mongering, appeals to selfishness, and quietly shifting the terms of the debate–fail when these results are made clear.
We just need to present such results correctly: “Even when you exclude availability and affordability of care from consideration, Canadian medicine is equal or better, on qulaity and outcomes bases.”
In his June 10 NYT op-ed, This Time, We Won’t Scare, Nicholas Kristof compares the US and Canadian systems, from which,
The biggest difference is that in Canada we live and die without the fear endemic to the US system. We know there is care when we need it. We can get treated when we need to be treated.
And it’s not spartan. My best friend’s mother died on Monday after a very long battle with breast cancer. She was in the palliative unit at Princess Margaret Hospital in Toronto. It was luxurious. There was space for the extended family to be with Mary Ellen. There was the right mix of drugs to deal with pain and anxiety.
And they left the hospital weeping with grief, but not fear about paying the bills.
Thanks for sharing your story, I know some of those Docs over at Princess Marg and they are a great group !
Hugs to you and the family of Mary Ellen
Another thing about outcomes:
If Canadians get swine flu-like symptoms, we go to the doctor. Americans make a trade off, and many don’t get diagnosed or treated.
Who would you rather be in an epidemic or other public health emergency? A platinum insured American or a one size fits all-insured Canadian?
All the specialists in the world can’t help if the person behind you in line at the grocery store is coughing because they don’t know how sick they are.