’d rather hear what you think of the bashing Canada’s health care system has been getting all summer long in the American media. Has anyone gotten anything right about it in the US? Anything particularly egregiously twisted out of shape, or even outright made up? Face it: in the world of comics geeks, you’re the top go-to wonk on this subject.
I HAS A NICHE
Ahem. Anyway, the list of things “egregiously twisted out of shape, or even outright made up” by politicians and theoretically-journalists in the United States about the Canadian health care system is fucking legion. It never seems to goddamn end, and let me tell you: as a Canadian, I speak for just about all Canadians when I say that this is one of the things that really pisses me off about Americans (who are generally quite a decent bunch, all things considered), because the root assumption Americans make when they say that Canadians have shit healthcare and die waiting in line and so forth is that we are a nation of idiots who don’t know any better, considering that we live right next door to the capitalist paradise that is American health care. That this sometimes comes out of ignorance makes it no less rude.
And yes, I know Canadians can be and often are just as guilty of the same behaviour in reverse, myself included. There is one underlying difference, though, which is this: when it comes to health care, we’re right (or at least more right), and America is wrong. We cover all of our population for less money per capita than America does, and by most metrics we deliver relatively equal or better health outcomes. Yes, sometimes people wait for elective procedures, but they get taken care of eventually.
All of this is ignored when Americans lie or, at best, cherry-pick data to make the Canadian health care system – which is not perfect by any means, but is really a perfectly decent health care system, really – seem like the seventh circle of Hell. For example, there’s this link, which purports the “superiority” of American health care. It’s been mad-linked on all the right-wing blogs the past few days. Let’s go through it.
1. Americans have better survival rates than Europeans for common cancers. Breast cancer mortality is 52 percent higher in Germany than in the United States, and 88 percent higher in the United Kingdom. Prostate cancer mortality is 604 percent higher in the U.K. and 457 percent higher in Norway. The mortality rate for colorectal cancer among British men and women is about 40 percent higher.
2. Americans have lower cancer mortality rates than Canadians. Breast cancer mortality is 9 percent higher, prostate cancer is 184 percent higher and colon cancer mortality among men is about 10 percent higher than in the United States.
These are based off a study in The Lancet, and note that they use “percent higher” rather than comparing the actual relative survival rates, which would tell you that the breast cancer survival rate in the United States is 83.9 percent compared to Germany’s 75.5 percent, because “52 percent higher mortality rate” sounds a lot scarier than “six point six percent greater chance of dying.” Of course, looking at the actual study (which is online! PDF here, courtesy The Globe and Mail), the authors also helpfully included information on relative survival rates over a period of years, and what happens is this: across the board, United States and pretty much everywhere else in the first world, survival rates usually tick upwards a bit gradually over time (because if you survive the first six months after you find out you have cancer, odds are you’ll survive for years even if it doesn’t go into remission).
What this tells us is that the United States’ advantage in cancer mortality rates is primarily a result of additional screening. This is one benefit of a for-profit system: the tendency for doctors to want to do lots of tests which makes the hospital money means you catch more diseases you weren’t expecting to find. Nobody argues that you catch more cancer this way. I’m just saying that, bang for the healthcare buck, this might not want to be how you spend your money.
Incidentally, when you translate those Canada/US comparison numbers into actual survival percentages, they are
Breast cancer: 83.9% survival rate USA, 82.5% Canada
Colon cancer, men: 60.1% USA, 56.1% Canada
Prostate cancer: 91.9 USA, 85.1% Canada
Now, I could rattle off some statistics about various mortality rates of non-cancer diseases and how we’re better than America at those, but that would be classless. Oh, and our system covers half of what yours does and we cover everybody.
3. Americans have better access to treatment for chronic diseases than patients in other developed countries. Some 56 percent of Americans who could benefit are taking statins, which reduce cholesterol and protect against heart disease. By comparison, of those patients who could benefit from these drugs, only 36 percent of the Dutch, 29 percent of the Swiss, 26 percent of Germans, 23 percent of Britons and 17 percent of Italians receive them.
It takes a peculiar set of balls to take one type of medication and suggest that its advanced use in the United States is proof that Americans have better access to treatment for chronic diseases. There’s nothing actually stopping that German, Italian or Ned Nederlander from requesting that a doctor prescribe statins; that’s got more to do with overall medical culture and what doctors in any given country tend to think is the best prescription for their at-risk high-cholesterol patient. There really aren’t government bureaucrats hovering behind doctors’ shoulders saying “no statins for you!”
Here’s one more thing they didn’t say about chronic diseases: the vast majority of them tend to come in late age. When Americans are elderly, who cares for them? Medicare. That’s right – the dreaded gubmint is managing most treatment of American chronic disease, and getting those people their delicious statins.
4. Americans have better access to preventive cancer screening than Canadians.
Totally conceding this one; it’s part of different medical cultures, and one of the few strengths of the American system. Congrats, America! That makes your relatively low life expectancy look much better now.
5. Lower-income Americans are in better health than comparable Canadians. Twice as many American seniors with below-median incomes self-report “excellent” health compared to Canadian seniors (11.7 percent versus 5.8 percent). Conversely, white Canadian young adults with below-median incomes are 20 percent more likely than lower income Americans to describe their health as “fair or poor.”
“Self-reporting” is another way of saying “the authors of the study used a couple of phone surveys.” That’s awful scientific-like.
Especially when you consider that their choice of surveys had less than 3500 contacts in the United States and 2600 in Canada; that’s a really small sample size. Correction: Chris Russell, in comments, points out that my stats math is way out of practice re: sample sizes, but self-reporting is still questionable in my view.
Incidentally, the actual authors of the study referred to here concluded that the American and Canadian systems were roughly comparable in terms of outcome, with various defiencies more or less equalling out. They also didn’t claim that their report on the surveys was in any way definitive.
(They also didn’t mention that we spend half as much as you do and cover everybody.)
6. Americans spend less time waiting for care than patients in Canada and the United Kingdom. Canadian and British patients wait about twice as long – sometimes more than a year – to see a specialist, to have elective surgery like hip replacements or to get radiation treatment for cancer. All told, 827,429 people are waiting for some type of procedure in Canada. In England, nearly 1.8 million people are waiting for a hospital admission or outpatient treatment.
This is one of the big bugbears of the anti-single-payer movement in the USA: waiting lists. “You’ll die waiting in line!” Of course, the reason they have access to our wait-list data is because our countries actually track how long one has to wait for care. The United States has no centralized collection of health data of this sort. But of course you wait for care: see here or here. Americans wait for care; they just don’t count how long they wait. (And they don’t count people who can’t afford to visit a doctor in the first place, who effectively have a wait time of forever, or until they die, whichever comes first.)
I’m also curious how the writers of this list of facts gleaned that wait times are “twice as long” given their cite for it, the Fraser Institute report, doesn’t have any comparison between American and Canadian wait times.
7. People in countries with more government control of health care are highly dissatisfied and believe reform is needed. More than 70 percent of German, Canadian, Australian, New Zealand and British adults say their health system needs either “fundamental change” or “complete rebuilding.”
This one is just retarded. Everybody bitches about health care – as evidenced by the fact that more than eighty percent of Americans say the same thing. Of course, the percentage of Americans saying “scrap it and let’s try something else entirely” is about double or more than just about every other country surveyed except Germany. (Which is weird, because Germany’s system is generally well-regarded by experts. My guess: Germans are mopey.)
Plus, “fundamental change” can mean a lot. I’d say the Canadian system needs fundamental change: we need more doctors and nurses, which means dramatic shifts in how we regulate their certification and education, plus we also need to strongly de-emphasize emergency room reliance, introduce universal electronic recording, and find a better system of dental and optical coverage (which the government doesn’t cover and which can decimate low-income Canadians’ health). And we should find a way to introduce some private-tier care eventually (but not until this big country directly south of us evidences some sanity in their care decisions). That’s a lot of change. That’s pretty fundamental! But that doesn’t mean I don’t think my health-care system is, on the whole, pretty good overall.
8. Americans are more satisfied with the care they receive than Canadians. When asked about their own health care instead of the “health care system,” more than half of Americans (51.3 percent) are very satisfied with their health care services, compared to only 41.5 percent of Canadians; a lower proportion of Americans are dissatisfied (6.8 percent) than Canadians (8.5 percent).
They went to the same well they went to for point #5; these are the self-reporters again. Personally, my guess is that if you’re called up and asked if you like your health care, you’re more likely to say “yes” when you’re at least partially responsible for determining if you have care. Because if you have health insurance you paid for and you don’t like it, doesn’t that make you sound like a dumbass? Whereas if the gubmint leaves you out of the decision, then you’re free to bitch because, hey, it’s the gubmint.
Of course, I could just go back to those OECD numbers: 34 percent of Americans say “scrap the health care system entirely” versus 12 percent of Canadians. I mean, that’s only nearly triple.
9. Americans have better access to important new technologies such as medical imaging than do patients in Canada or Britain.
This is true too; it’s the other major benefit of a for-profit health care system. You get neater toys.
10. Americans are responsible for the vast majority of all health care innovations.
True, but America is generally responsible for the majority of scientific research period. In their article, the authors list four of the “ten most important” health care innovations as being solely American in origin: ACE inhibitors, coronary artery bypass graft surgery, SSRIs and cataract surgery. (The Americans also share credit for proton pump inhibitors, MRIs/CTs, statins and knee replacements, but unfortunately must share that credit with the filthy health-commies of Britain, Sweden and Japan.) That having been said, most of these discoveries predate Richard Nixon’s decision to privatize the American health insurance market, so I’m not sure how well they reflect upon the for-profit system as an innovator of care.
Understand that this is a relatively scholarly attempt to make Canada’s health system look worse than America’s, and it is full of holes, half-truths, distortions, irrelevancies, and bullshit – but compared to the output of your average Republican member of Congress, it’s the Encyclopedia Britannica. There simply is not enough time in the day for me to cover every smear, swipe and outright lie told about Canada’s healthcare system by Americans (and the occasional opportunistic Canadian). If you guys have specific things you want to ask about, have at it in comments.