This is an
excellent debunking of the false story line around Canada’s Medicare
system. The Canadian system does have
its flaws but that is easily checked against other solutions elsewhere for developing
a roadmap to improvement. The USA is not
yet one of those.
The Canadian
system is capable of getting even more cost effective and even more responsive
through system wide initiatives. There
is constant experimentation underway to do that. Even better, a test can be run in one
province and quickly copied elsewhere.
It may not
seem dynamic, but all political pressure is aimed at local cost
management. There is no agency in
position to game the price structure upward, in fact it is quite the opposite.
5
Myths About Canada’s Health Care System
The
truth may surprise you about international health care
How does the U.S.
health care system stack up against Canada’s? You’ve probably heard allegedly
true horror stories about
the Canadian system — like 340-day waits for knee replacement surgery, for
example.
To separate fact from fiction, Aaron E.
Carroll, M.D., the director of the Center for Health Policy and Professionalism
Research in Indianapolis, identified the top myths about the two health care
systems.
Myth #1: Canadians are flocking
to the United States to get medical care.
How many times have you heard that Canadians,
frustrated by long wait times and rationing where they live, come to the United
States for medical care?
I don’t deny that some well-off people might
come to the United States for medical care. If I needed a heart or lung
transplant, there’s no place I’d rather have it done. But for the vast, vast
majority of people, that’s not happening.
The most comprehensive
study I’ve seen on this topic — it employed three different methodologies, all
with solid rationales behind them — was published in the peer-reviewed
journal Health Affairs.
How Many Canadians Use
the U.S. Health System?Do not come to the US for care: 99.39%Come to US for
care electively: 0.5%Use the US for emergency care: 0.11%
The authors of the study started by surveying
136 ambulatory care facilities near the U.S.-Canada border in Michigan, New
York and Washington. It makes sense that Canadians crossing the border for care
would favor places close by, right? It turns out, however, that about 80
percent of such facilities saw, on average, fewer than one Canadian per month;
about 40 percent had seen none in the preceding year.
Then, the researchers looked at how many
Canadians were discharged over a five-year period from acute-care hospitals in
the same three states. They found that more than 80 percent of these hospital
visits were for emergency or urgent care (that is, tourists who had to go to
the emergency room). Only about 20 percent of the visits were for elective
procedures or care.
Next, the authors of the study surveyed
America’s 20 “best” hospitals — as identified by U.S. News & World Report —
on the assumption that if Canadians were going to travel for health care, they
would be more likely to go to the best-known and highest-quality facilities.
Only one of the 11 hospitals that responded saw more than 60 Canadians in a
year. And, again, that included both emergencies and elective care.
Finally, the study’s authors examined data
from the 18,000 Canadians who participated in the National Population Health
Survey. In the previous year, 90 of those 18,000 Canadians had received
care in the United States; only 20 of them, however, reported going to the
United States expressively for the purpose of obtaining care.
Myth #2: Doctors in Canada are
flocking to the United States to practice.
Every time I talk about health care policy
with physicians, one inevitably tells me of the doctor he or she knows who ran
away from Canada to practice in the United States. Evidently, there’s a general
perception that practicing medicine in the United States is much more
satisfying than in Canada.
Problem is, it’s just not so. Consider this
chart:
The Canadian Institute for Health Information
has been tracking doctors’ destinations since 1992. Since then, 60 percent to
70 percent of the physicians who emigrate have headed south of the border. In
the mid-1990s, the number of Canadian doctors leaving for the United States
spiked at about 400 to 500 a year. But in recent years this number has declined,
with only 169 physicians leaving for the States in 2003, 138 in 2004 and 122
both in 2005 and 2006. These numbers represent less than 0.5 percent of all
doctors working in Canada.
So when emigration “spiked,” 400 to 500
doctors were leaving Canada for the United States. There are more than
800,000 physicians in the United States right now, so I’m skeptical that every
doctor knows one of those émigrés. But look closely at the tan line in the
following chart, which represents the net loss of doctors to Canada.
###
In 2004, net emigration became net
immigration. Let me say that again. More doctors were moving into Canada than
were moving out.
Myth #3: Canada rations health
care; that’s why hip replacements and cataract surgeries happen faster in the
United States.
When people want to demonize Canada’s health
care system — and other single-payer systems, for that matter — they
always end up going after rationing, and often hip replacements in particular.
Take Republican Rep. Todd Akin of Missouri,
for example. A couple of years ago he took to the House floor to tell his
colleagues:
“I just hit 62, and I was just reading that in
Canada [if] I got a bad hip I wouldn’t be able to get that hip replacement that
[Rep. Dan Lungren] got, because I’m too old! I’m an old geezer now and it’s not
worth a government bureaucrat to pay me to get my hip fixed.”
Sigh.
This has been debunked so often, it’s tiring.
The St. Louis Post-Dispatch, for example, concluded: “At least 63 percent of
hip replacements performed in Canada last year [2008] ... were on patients age
65 or older.” And more than 1,500 of those, it turned out, were on patients
over 85.
The bottom line: Canada doesn’t deny hip
replacements to older people.
But there’s more.
Know who gets most of the hip replacements in
the United States? Older people.
Know who pays for care for older people in the
United States? Medicare.
Know what Medicare is? A single-payer system.
Myth #4: Canada has long wait
times because it has a single-payer system.
The wait times that Canada might
experience are not caused by its being a single-payer system.
Wait times aren’t like cancer. We know what
causes wait times; we know how to fix them. Spend more money.
Our single-payer system, which is called
Medicare (see above), manages not to have the “wait times” issue that Canada’s
does. There must, therefore, be some other reason for the wait times. There is,
of course. It’s this:
###
In 1966, Canada implemented a single-payer
health care system, which is also known as Medicare. Since then, as a country,
Canadians have made a conscious decision to hold down costs. One of the ways
they do that is by limiting supply, mostly for elective things, which can
create wait times. Their outcomes are otherwise comparable to ours.
Please understand, the wait times could be
overcome. Canadians could spend more. They don’t want to. We can choose to
dislike wait times in principle, but they are a byproduct of Canada’s choice to
be fiscally conservative.
Yes, they chose this. In a rational world, those
who are concerned about health care costs and what they mean to the economy
might respect that course of action. But instead, they attack the system.
Myth #5: Canada rations health
care; the United States doesn’t.
This one’s a little bit tricky. The truth is,
Canada may “ration” by making people wait for some things, but here in the
United States we also “ration” — by cost.
An 11-country survey carried out in 2010 by
the Commonwealth Fund, a Washington-based health policy foundation, found that
adults in the United States are by far the most likely to go without care
because of cost. In fact, 42 percent of the Americans surveyed did not express
confidence that they would be able to afford health care if seriously ill.
Further, about a third of the Americans
surveyed reported that, in the preceding year, they didn’t go to the doctor
when sick, didn’t get recommended care when needed, didn’t fill a prescription
or skipped doses of medications because of cost.
Finally, about one in five of the Americans
surveyed had struggled to pay or were unable to pay their medical bills in the
preceding year. That was more than twice the percentage found in any of the
other 10 countries.
And remember: We’re
spending way more on
health care than any other country, and for all that money we’re
getting at best middling results.
So feel free to have a discussion about the
relative merits of the U.S. and Canadian health care systems. Just stick to the
facts.
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