Obamacare can be described as a lot of different things, but it surely is not socialized medicine. No self-respecting socialist would favor having the government write checks for 16 million people to buy coverage from private (and often for-profit) private health insurance companies. Plus, the Affordable Care Act maintains the employer-based coverage system from which the vast majority of Americans will continue to get coverage. Heck, it doesn’t even have the public option favored by liberals!
I write this blog today from a country that has the real thing: Canada! ACP’s Board of Governors is meeting this week in beautiful Vancouver, British Columbia. Coincidentally, one of the policy resolutions being debated this morning by the governors is a call for ACP to support a single payer system, like Canada’s. (Resolutions can be introduced by any ACP chapter, so the fact that this resolution is being discussed does not mean that it is, or will become, ACP policy. Plus, resolutions adopted by the Board of Governors are advisory to the College’s Board of Regents, which has the final authority to set organizational policies.)
So what can we learn from Canada? I wouldn’t say that my brief visit here makes me an expert on Canada’s socialized healthcare system. But so far, I haven’t seen masses of extremely ill patients desperately queuing up in long lines to get health care from beleaguered doctors and hospitals, even though this is the image conjured up by critics of Canadian healthcare, such as this description from a conservative Canadian physician “Thus, at a time when Canada’s population was aging and needed more care, not less, cost-crunching bureaucrats had reduced the size of medical school classes, shuttered hospitals, and capped physician fees, resulting in hundreds of thousands of patients waiting for needed treatment—patients who suffered and, in some cases, died from the delays.”
Actually, the Canadians I’ve seen in this Pacific Northwest coast city seem pretty darn fit and healthy! But casual observations, of course, aren’t really a fair way to evaluate Canada’s socialized healthcare system. It is certainly possible that lurking behind a seemingly healthy and contented Canadian population is a system that is denying needed care and causing unnecessary suffering and death.
So instead of casual observation and conjecture, what does the evidence tell us about Canada’s experience and how does it compare to the United States?
The highly respected, non-partisan Annenberg Public Policy Center runs a website, www.factcheck.org, that factually evaluates the evidence behind competing public policy claims. It’s short answer to the question “Is health care better in Canada?” is that “ Wait times are longer in Canada, but health and doctor quality don’t seem to suffer.”
More specifically, the Annenberg Center reports that “A study by the Commonwealth Fund, a nonpartisan research foundation that promotes improved health care access and quality, showed that 57 percent of adults in Canada who needed a specialist said they waited more than four weeks for an appointment, versus only 23 percent who said so in the U.S. For emergency physician visits, 23 percent of Canadians and 30 percent of Americans said they could get in to see the doctor the same day, but 23 percent of Americans and 36 percent of Canadians waited more than six days. Wait times for elective and non-emergency surgery were even more disparate: Thirty-three percent of Canadians reported a wait time of more than four months, but only 8 percent of Americans had to wait that long. In another study, 27 percent of Canadians said that waiting times were their biggest complaint about their health system, versus only 3 percent of Americans.”
But wait a minute, does Canada’s longer waits for some specialty care result in poorer clinical outcomes and poorer health? No, says the Center, because “on most measures of patient-reported physician quality, Canada comes out slightly ahead of the U.S. . . Fewer reported physician errors, lab errors, medication errors and duplicate tests north of the border, and Canadians report more satisfaction with their doctors. General health is also better up north, according to the World Health Organization: Life expectancy and healthy life expectancy are both higher in Canada; infant mortality is lower, and maternal mortality is significantly lower. There are fewer deaths from non-communicable diseases, cardiovascular diseases and injuries in Canada, though marginally more deaths from cancer. It’s not clear how much of the divergence is attributable to medical care, rather than other standard-of-living differences between the two countries . . . But these statistics simply don’t support the notion that universal, single-payer health care is crippling the health of Canadian citizens compared with that of U.S. citizens.”
And the Center reports that both the Canadian or U.S. healthcare “score low on health measures compared with other industrialized nations. “In the Commonwealth Fund’s overall ranking of health system performance, Canada came in fifth and the U.S. came in sixth, out of six countries. On the other hand, the WHO’s 2000 World Health Report gave Canada a slightly better review, ranking it 30th for overall health system performance – above three of the other countries from the Commonwealth study (Australia, New Zealand and the U.S.) but below the other two (the U.K. and Germany). All of these countries, except the U.S., have publicly funded health care, as does every major country in the WHO’s top ten.”
My take-away is that Canada’s system, like the U.S, has strengths and weaknesses. Canada isn’t the healthcare Nirvana that some liberals believe it to be, but neither is it the healthcare hell that conservatives describe. It is a system that covers everyone, with lower administrative costs and at a much lower overall cost than the United States, with longer waits for some care than U.S. residents are accustomed to, but with comparable (and in some cases better) outcomes. The U.S. provides coverage to only 85% of its residents, leaving 46 million without health insurance. We don’t wait as long for care as our northern neighbors, but our outcomes are no better (and in some cases worse) and it costs us much, much more. Obamacare would take us a step closer to Canada, in the sense of extending coverage to 92% of U.S. residents, but through a decidedly non-socialistic model of subsidized private and public health coverage, at a much higher cost.
Today’s questions: What is your view of single payer healthcare and the Canadian healthcare system? Do you foresee it ever being adopted by the U.S.?