The many myths of Canadian health care
A few things in the health care debate have been riling my feathers lately. The first is yesterday's post by Ezra Klein examining how the folks over at the right-leaning The Corner are busy questioning the definition of "is". Ramesh Ponnuru writes:
I don't think [universal health care] is possible, actually. If you can't get an operation because your country's national health insurance system has you on a long waiting list, in what sense have you enjoyed "universal coverage"?
Ezra goes on to discuss how one can, in fact, define universal, and that definition is "everyone in the population receiving health insurance".
Jon Cohn addresses the latter part of Ponnuru's argument over at The New Republic's blog, the Plank, and dug into the stats on waiting lists:
Here's the summary findings from an exhaustive survey by the Organization for Economic Cooperation and Development (OECD):
The health system in France is regarded as delivering high quality services, with freedom of choice and generally no waiting lists for treatments.
--Page 69, sourced to a 2000 study by a trio of academicsAnd: In Germany, "Waiting lists and explicit rationing decisions are virtually unknown."
--Page 70, citing a World Health Organization study.
If Ramesh knows something the OECD doesn't, I'd love to hear about it.
I'm going to throw myself into the fight here, and debunk another favored myth of the Right, which is that the Canadian health system is so bad, millions of Canadians come here for their health care.
A 2002 Health Affairs paper examined hospitals near the border, as well as national surveys to tease out how many Canadians actually visit the U.S. to receive elective procedures.
In terms of hospitals along the border offering advanced treatments or special diagnostic technology (i.e. CT scans and MRIs), about 640 Canadians were seen, along with 270 for procedures like cataract surgery. They compare this to about 375,000 and 44,000 similar procedures in the region of Quebec alone during the same period. If you divide the total number of Canadians seeking those treatments in the US, divided by the number in Quebec alone that's about 0.09%. Not even a tenth of a percent.
But the most striking stats come from the Canadian National Population Health Survey (NPHS). From the article:
Only 90 of 18,000 respondents to the 1996 Canadian NPHS indicated that they had received care in the United States during the previous twelve months, and only twenty had indicated that they had gone to the United States expressly for the purpose of getting that care.
Only 20 of 18,000 sought care in the United States. I can't believe how many people are coming over here! Their system but be truly awful.
But let's give this number some context. We've all heard about seniors getting their prescriptions from Canada. (Hell, even driving to visit my sister at college in rural Kansas, I saw a billboard for "Canada Drug of Topeka!") But how many seniors really do that? Is it exaggerated, like the claims of Canadians coming stateside?
Polling data from 2003 (approximately a year after the Health Affairs article) indicates that 8% answered YES to the following question:
"Have you ever bought prescription drugs from Canada or other countries outside the United States in order to pay a lower price?"
If 8% of the 18,000 Canadians polled in NPHS had expressly sought care in the United States, that would be 1,440. Not 20, as the survey showed.
In other words, we have 72 times the number of Canadians seeking care in the US going to Canada (or at least calling there) to get prescriptions.
What angers me so much about the Right's rhetoric on health care reform is that their arguments are so weak that they're now essential questioning the definition of "is".
Universal health care has been achieved in dozens of nations on this planet. One of which has some waiting lists, while others have essentially none. According to surveys, less than 0.1% of Canadians are expressly seeking care in the U.S.
The bottom line is our health care is twice as expensive, fails to cover 46 million people, has questionable quality, kills around 100,000 people a year from error, and for all this we have worse health indicators (i.e. lower life expectancy, higher infant mortality, etc). Other countries do it better, and they do it with the help of government to pay for health costs.
We can at least move to a system where everyone has health insurance (and yes, we call that "universal"). Or, you can believe the folks over at the Corner who are arguing that kind of coverage doesn't exist.
What do you want?
Totally agree.... now practice saying it faster:
MEDICARE FOR AMERICANS
Why? Two numbers: 3% and 12%
What are those? The amount of money spent by health insurance companies on administrative overhead (3% is Medicare, 12% is the average for private insurers).
How does that help? If we simply moved everything over to Medicare the cost savings in administrative overhead ALONE would pay for the premiums of the 46 MILLION Americans who currently have no insurance.
More coverage, less money, right away....which one of those do you have a problem with?
===
"There is some background noise here, a lot of chatter, a lot of speculation and opining."
- George Bush, Oct. 20, 2005
April 26, 2006 11:11 AM | Reply | Permalink
I'm not sure where you are getting your 12% number. Many studies put the figure at closer to 30%. For-profit health companies expect to make a profit of about 15%. Add to that the higher salaries, stock options and other expenses of a for-profit firm compared to goverment and you can see what happens to the costs.
Just a single example I like to mention. NY Blue Cross used to be a non-profit insurance plan. It advertised that about 96% of the premiums it collected went back to pay for patient benefits.
Recently it became for-profit. It now brags about a payback of about 75% to subscribers. What's the difference - the profit.
--- Policies not Politics
Daily Landscape
April 26, 2006 11:55 AM | Reply | Permalink
I pay for my own health insurance, even though I am employed, because I can get coverage cheaper on my own than what my employer offers.
Why is that?
I don't know, but it's not for the reason you probably expect.
No, I don't work for a little mom-and-pop outfit. I work for one of the largest military/civilian contractors in the country. When they took over our contract last year, our insurance premiums quadrupled. Yes, quadrupled, to over a thousand dollars a month.
In other words, approximately 1/3 of my total salary.
A health insurance tax paying for universal health care would cost everyone a lot less than a third of their pay.
But the horror of socialized medicine is ingrained into the American psyche. It's going to take years of reeducation to change that, and reeducation can't take place in this media environment, much less when Democrats depend on health insurance corporate campaign contributions to get elected.
Step 1 is get the money out of our election cycle. End the system of legalized bribery we know as political contributions.
Step 2 is move our elections back into the public domain and out of the hands of private corporations with political agendas.
Without Steps 1 and 2, step 3, universal health care (as opposed to 'affordable health insurance') isn't going to happen.
April 26, 2006 12:36 PM | Reply | Permalink
As a Canadian, I definitely find it irritating when myths about our health care system are dragged into debates about health care in the US. Based on over three decades of first-hand experience with the health care system here I can assure people that Canadians have access to excellent care. There are lots of issues and problems with the Canadian system, and I'm sure it can be improved. However, its totally erroneous to portray us as receiving poor health care. So I agree with this post.
April 26, 2006 12:55 PM | Reply | Permalink
I agree with every word you said, but just a reminder: don't get cancer, diabetes, depressed, or any other thing that will make your premiums, copays and deductibles skyrocket as a privately insured person. At least if any of those things happen to you, you'll have the option (during enrollment season, anyway) of getting back into your employer's policy.
I just got a job, and my insurance is also expensive, but prior to that I was paying my own way. With my history of breast cancer and back pain, I ended up with an ANNUAL DEDUCTION of $5,000 -- yep! that is before they would pay one penny, even though I was paying them $4,000 a year in premiums. In other words, if I got sick or needed surgery I would be out of pocket at least $9,000 before they would pick up any of it, and come January of each year it would start all over again.
We desperately need universal health care, and take the profit away from it because it puts the emphasis away from preventive health care, and puts it solely on lining the pockets of the insurance industry.
Jan Knaus
April 26, 2006 1:05 PM | Reply | Permalink
Aidan, Thanks for responding, but please understand -- most of us know that what you say is true. It is just another republican talking point to keep people in fear of changing our wonderful (?!?!?!?!) system so that the powers-that-be can keep their $$$$$.
Jan Knaus
April 26, 2006 1:08 PM | Reply | Permalink
Jan, that's what I'm paying now for family care with NO adverse health history. Our family deduction is $9,000 annually.
And this is BETTER than what our employer insurance offers.
April 26, 2006 2:37 PM | Reply | Permalink
RFD
>I'm not sure where you are getting your 12% number. Many studies put the figure at closer to 30%.
If you are using averages, 12% is about right for administrative overhead of health insurance companies
30% is all administrative costs - those in hospitals and doctors offices, as well. As I understand it total administrative costs for Canada are about 12%. So 18 cents out of every U.S. dollar goes to administrative costs we have and Canada does not. Kate can probably confirm whether the 12% total for Canada is right. I know it is not too far off, but from memory so not precise.
April 26, 2006 3:25 PM | Reply | Permalink
Aidan:
Find the Truth. Do Justice.
April 26, 2006 3:26 PM | Reply | Permalink
We (the US) live in a "for profit" medical system. Given this fact, what is the best way to generate maximum profits?
Preventive health care? No.
Minimal use of drugs with emphasis on holistic treatment options? No.
Programs to encourage healthy lifestyles and proper diet? No.
The best profit attainable would be an unhealthy population, addicted to prescription drugs, paying the maximum sustainable amount that fits within the budgets of the middle class and up (the poor and uninsured are to be ignored unless it's a absolute emergency and the treatment would be required by law).
Sounds a lot like the system we have.
April 26, 2006 5:04 PM | Reply | Permalink
The most highly compensated CEO in Minnesota is the head of United Health Group. He pulls in over $100M and has accumulated over $1.5B in stock options.
April 26, 2006 5:09 PM | Reply | Permalink
Wow! I didn't think it was possible to get a deal that bad. This is terrible! One reason it is so hard to change is that the federal employees (read Congress) have an absolutely golden policy. My father retired from the Post Office, and my mother does not pay one cent for anything; not even a co-pay for medications. Oh, I take that back. She goes to the gym twice a week for personal training because of smoking for 60 years, and she pays $5 for each visit.
Do you ever wonder about things like, Does Scott McClellan lose his health benefits, or do people like him get a life-time deal because they were with the White House? Anyway, the people with the power have a double incentive not to change:
1) If a truly universal system got into place they would likely have worse coverage than they do now.
2) Insurance companies are giving them big bucks to maintain the status quo.
There will have to be a more obvious crisis than we have even now for a change to occur, I guess.
Jan Knaus
April 26, 2006 5:53 PM | Reply | Permalink
Waiting Lines? You want waiting lines? We've got waiting lines.
Independent Illinois Grassroots: IllinoisDemNet.com
April 26, 2006 7:21 PM | Reply | Permalink
My family, American citizens with landed immigrant status in Canada, swear by the Canadian system. She has had some serious surgery without any waiting. The stories by the National Review are lies like all their material.
April 26, 2006 8:50 PM | Reply | Permalink
I have seen a range of numbers, so I put the lowest one in because it still pays for everything we want. And I didn't want to get into a debate about whether the number was inflated, etc. But yeah...the spread is even larger than I said it was.
"There is some background noise here, a lot of chatter, a lot of speculation and opining."
- George Bush, Oct. 20, 2005
April 26, 2006 10:18 PM | Reply | Permalink
I was just focusing on administrative overhead.
We have to keep this simple, because as someone noted upstream we have tons of propaganda and fear mongering over "socialized medicine" that has to be purged from the system.... lay a debate of dollars and cents on that and people's eyes glaze over.
Medicare for Americans.
Lower costs, more coverage, right now...which one of those don't you like?
"There is some background noise here, a lot of chatter, a lot of speculation and opining."
- George Bush, Oct. 20, 2005
April 26, 2006 10:23 PM | Reply | Permalink
You can refer to this New England Journal of Medicine article: http://content.nejm.org/cgi/content/abstract/349/8/768
30% total administration for the US, 16.7% for Canada.
April 27, 2006 7:55 AM | Reply | Permalink
We don't have experience with the Canadian health care system, but we do have experience with the German system. When we were in Munich a few years ago, my partner was diagnosed with a deep vein thrombosis in the leg. The diagnosis was made by the doctor who, himself, ran an ultrasound in his office. There was no requirement for intermediaries, such as technicians to run the tests and drive up costs.
After the diagnosis, he was immediately taken to the local hospital, where he remained for a week. In the US, it would have been treated on an outpatient basis.
Total cost, including numerous tests, was on the order of US$5k, which was reimbursed by our US insurer.
The idea that the US system is better than those of other industrialized countries is preposterous.
April 28, 2006 3:33 AM | Reply | Permalink
1/3 your salary for health insurance?!? $5000?!? $9000 ?!?
Honestly, I cannot for the life of me figure out why Americans are not rioting in the streets. Clearly there are more than enough reasons. This healthcare issue alone, one would hope, would raise the ire of the common man... seriously. Over 40% of Americans have no health coverage at all! People accept that? Is that seriously how a progressive society is supposed to treat its population?
I'm Canadian and I pay $54 per month for basic medical coverage. My employer pays for my extended medical coverage (as is normal for most all employers) which is, I believe, about an additional $90 per month - it covers chirpractic, corrective lenses, dental, etc. Everybody gets basic coverage. If you can't afford the monthly payments, you can apply for assistance.
Americans, it seems, have been bamboozled. Your whole country is run by corporations. As mentioned by someone above, your healthcare system is merely a symptom of the much larger problem posed by a government catering to big business. "By the People, For the People" was a long time ago but I hope to hell that the American people reclaim their government before its too late. In the meantime, I'm happy to be Canadian.
June 16, 2006 12:15 AM | Reply | Permalink
There is no doubt that the heath care system still has a long way ahead before it can recover from this "universal" crisis. We need to think straight to the point there, from simple to complex. A change is what we need and by the way I don't believe in myths.
Canada drugs
January 2, 2008 6:42 AM | Reply | Permalink