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August 25, 2005

The Great White Hope

How bad is our health care system? Bad enough that Canadian doctors, who get paid twice as much if they practice here rather than there, are fleeing back north. Fantastic.

August 25, 2005 | Permalink

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Ezra,
How do you reconcile stats like these from the NCPA on the Canadian HealthCare system? Are they just lying or wrong?

For many Canadians their 37-year-old universal health-care system is the symbol of their national identity. However, last June, a majority of Canada's Supreme Court struck down a Quebec law that banned private health insurance and held that the public system inflicted cruel and unusual punishment on many of its patients.

According to the Fraser Institute:

The average Canadian waits 17.9 weeks between the time a patient makes an appointment to see a general practitioner and when he then sees a specialist.
He will then be treated by a system that ranks 13th out of 22 advanced countries in access to MRI technology; 17th out of 21 in access to CT scanners and seventh out of 22 in access to radiation machines.
The safety valve in the system is that nearby U.S. hospitals can provide treatment for emergency cases and patients willing to pay. But Canada's public care doesn't save money, says columnist John H. Fund:

When adjusted for the age of its population, Canada vies with Iceland and Switzerland as the highest spender on health care among the 28 most developed nations with universal systems.
David Gratzer, a Toronto physician affiliated with the Manhattan Institute, calculates that a Canadian earning $35,000 a year pays a stunning $7,350 in health-care taxes.

http://www.ncpa.org/newdpd/dpdarticle.php?article_id=2112

Posted by: Fred Jones | Aug 25, 2005 11:12:58 AM

Well, the last part is simply stupid. We have the per capita number on health care spending. In 1999, Canada came in 14th, America 1st. That's how it always is. We spend twice as much as the nearest competitor, Switzerland. As for the second part, Canadians do wait onger. Not in life-threatening situations, but longer. As for the tech access, I don't care. Canada tends to have better health outcomes, and other countries, notably Japan and France, have more access to techonlogy than we do, not to mention more doctors and hospital beds.

But I can give you a better answer than that. Canada has 4.2 MRI units per million. America has 84. We win! But wait! The Swiss have 17.4! The Japanese 35.3! It's an ass-kicking!

As for CT scanners, same deal. Canada has 9.7, we have 12.8, Germany has 13.3, Japan has 92.6 Another ass-kicking.

Gotta say, though, whether every million people has four more MRIs or not is a uniquely American way of making our health care look not as bad. And considering how much more we spend, if Canada wanted to bring expenditures per capita to where ours are, they could trounce us on MRIs.

But I've answered your questions. Now answer mine. How do you respond to the Gladwell quote from two days ago? Don't run away from it, or beat around the Bush, I want a straight up refutation of its claims, just like I gave you.

Posted by: Ezra Klein | Aug 25, 2005 11:31:06 AM

Incidentally, it should be said that the Canadian system can be mediocre while the American one is bad. Right wingers like to use every flaw up north as a way to discredit a whole way of providing health care, but that's fairly silly unless someone is arguing that we adopt what they do up north. As it is, I know a lot of people who like the French system, a couple who likes the Japanes, one who likes Britains but nobody, at least of the folks well versed in comparative health care structures, who's a big fan of Canada's.

On the other hand, I know of just about nobody who thinks ours is better than theirs. John Fund and the right win think tank you link to, for reasons of poor argument, cherry-picking of facts, and general incompetence on the subject, don't count.

Posted by: Ezra Klein | Aug 25, 2005 11:41:26 AM

How should one respond to Gladwell's article?
First he whines about how the choice of what Americans want is stupid and they must be stupid since they don't use the same earmarks of value and have rejected government single payer 6 times in the last hundred years. Nothing is mentioned of the value of self-determination and responsibility (yes, there are people out there who still value this). I also think that age-adjustment when making a cost comparison is hardly "cherry picking". Age is hugely related to costs.

Ya' know, we could also save a ton of money by reinstituting the "poor house" instead of mainstreaming the poor people via Section 8 housing but we don't because money is not the only consideration. Apparently, Americans also have non-monetary issues about healthcare that he does not care to address. C'mon....six times and each time was soundly rejected.

I guess my point would be that it is not a "done deal" that one-payer systems are inherently better in all respects and that not everyone agrees (except maybe in the liberal blogosphere) on the facts. There are other legitimate viewpoints on this issue.

Posted by: Fred Jones | Aug 25, 2005 12:41:44 PM

You've not answered a single factual claim in the article. All you've said is it's not a done deal because powerful special interest groups (notably the AMA and the insurance lobby) have been able to defeat it in the past. This is, I think, an important moment for you Fred. Are you here to discuss, debate and be honest, or just snipe? I answered your questions. I researched the numbers and returned with other facts. You've made an incoherent appeal to the wisdom of special interests (you know, by the way, that Americans, in polls, prefer Canada's system to our own?) and some random thing on choice, which happens to be a complete red herring considering the French, Japanese, and German systems all include more doctor choice than the American one. Not to mention that the French system simply has floor coverage, and you can then choose any private supplementary coverage you want.

You sniped at my piece here, you tried to quote a counter and it didn't pan out. Now what's the answer to me question? You here to discuss and learn and keep an open mind? I changed my opinion on HSA's because I decided, in some cases, I was wrong. Or are you just here to complain and attack?

Why does America pay more and get less? Why should America stick with a system that doesn't cover everyone, creates worse health outcomes, has higher administrative costs, and doesn't give us the most access to technology when it's more expensive than systems that do all those things?

Posted by: Ezra Klein | Aug 25, 2005 2:38:51 PM

First of all, you need to get a grip. I did not 'snipe' at your article. I pointed out that Gladstone is bewildered, with all of his cost data, why the public is not on board. Then I introduced the issues that he did not consider such as self-dtermination, control, wait times, etc.

One of the real problems you have is you set up the 'rules' by which this issue is judged and then try to beat up anyone that disagrees with your rules by complaining that they did not address the issue. In this case, cost by your definition (no adjustment for population age), number of MRI's etc.
I dispute none of Gladwell's facts, nor yours. Gladwell, in that quote, is mystified (as I believe you are) as to why a single payer Canadian-lke system has not been adopted after 6 tries in the last century. Having no other explanation you then blame the special interest groups and name the AMA and the insurance lobby. I'm sure they have had an influence on a couple of these tries, but insureance was not even a issue when some of these attempts to pass single payer were made and the AMA was not always the powerhouse that it is today.
What Gladwell and you have failed to understand is that when it comes to single payer, the public has not really been on board. They may poll so in the abstract until they see the details and then it's dead.

Again, my whole point was to show that this issue is not cut and dried as you have portrayed it to be. There are many measurements to value and then there's that pesky public that you must sell.

Posted by: Fred Jones | Aug 25, 2005 3:39:54 PM

I gotta be honest Fred, the problem is you have no idea what you're talking about. The AMA is a shadow of its former self. It's nothing compared to what it used to be. Read a history of health care, be it Quadagno's or Starr's and you'll learn that. The idea that single payer has been rejected by the people is simply untrue. It hasn't. It's been blocked by powerful special interests and we;ve lost the ad wars. Read Hackers, Skocpol's or Broder's histories of 1994 and you'd learn that.

As it is, you've yet to show me one measurement to contradict me. The rules I've set are empirical, show me one day when the people voted against health care (did you know, in exit polls of 1994, health care was one of the few issues Americans still trusted Democrats more than Republicans on?). You bring this strange CT/MRI factoid, i show you that other universal systems have more than we do. You bring this weird age adjusted number -- what is that? Is it government expenditures? Because -- hate to tell you -- but I read Health Affairs, which is an professional, unbiased (as in supporters and detractors of HSA and Bush contribute) journal, and there's absolutely no one who disputes that we spend twice as much as any other nation.

So cyes. I set the rules. Your argument has to make sense. You can't lie about the history of universal health care, you can't say the people don't want it then ignore their polls, you can't bring three meaningless facts and then ignore that they're refuted, and if you want to enter this argument, you have to be able to deal wiith the other side's claims. As it is, you want me to refute yours, but you don't want to refute mine.

By the way, Gladwell opposes the Canadian system. He lieks other ones, but he participated in a WaMo debate a few years back on why we shouldn't adopt Canada's system. Oh -- and in 1994, we didn't try for a Canadian system. We went for a complicated German one using the then unknown idea of managed care. Maybe if we;d gone the single payer route, it would've succeeded. Nah. Infustry money was too strong.

Posted by: Ezra Klein | Aug 25, 2005 7:06:23 PM

And my god -- could I have put any more typos in that last post?

Posted by: Ezra Klein | Aug 25, 2005 7:07:38 PM

Well, I can tell that you are passionate about this issue. However, if you believe (and it appears that you do) that the public is up in arms and clamoring for a single payer system and are, election after election, being thwarted by the big bad lobbyists, you're wrong. It really hasn't even been on the radar in the last few election cycles, ergo Gladwell's confession of confusion.
This reminds me of the gun control issue where the proponents firmly believe that the public deperately wants gun control and it's always the "powerful gun lobby" that prevents the will of the people.
Everytime it's pushed by the left, they realize that there is not the support that they thought for their cause. They, too, are mystified just like you and Mr. Gladwell.

Posted by: Fred Jones | Aug 26, 2005 9:53:58 AM

LOL, the right-wing noise machine is really pushing the "Canada's system was unconstitutional!" angle.

Of course, if you actually look at the decision, you see that Quebec's system was ruled as illegal under province law because it wasn't providing high quality care to every single resident. Tell me, if you're an American who's had to wait for a hip replacement for 6 months, who do you sue? If you can't get a hip replacement at all, what can you do? In Canada, someone is accountable for keeping promises about healthcare. In America, we just don't make promises.

In Canada, a system that fails to provide high quality care to everyone is an illegal system. In America, it's standard operating procedure.

Is this the argument you really want to be making?

Posted by: theorajones | Aug 26, 2005 12:26:03 PM

David Gratzer, a Toronto physician affiliated with the Manhattan Institute, calculates that a Canadian earning $35,000 a year pays a stunning $7,350 in health-care taxes.

I'm guess there is more to this number than meets the eye. But if it were true, I would say that is a little ridiculous. Thats 1/5th of one's salary. I don't know how you square that with per-capita spending.

The over 4th month waiting list for a specialist is ridiculous to. But I have a feeling Americans could do better than that. You know, America is in a unique position in that we have quite a few examples of government-run medicine to look at as ways to model our own. We also have a lot more money than those other countries to do so, which puts us at an advantage.

The main point being though, if we spend twice as much as other countries, we should be getting phenominally better care, or covering everyone, but we're not.

Posted by: Adrock | Aug 26, 2005 4:47:12 PM

In Canada, a system that fails to provide high quality care to everyone is an illegal system.

I would like to see everyone have access to healthcare. However, the sad fact is that many in the US *do*, but choose not to purchase the insurance that is available and affordable to them. If that is truly the case, is the *government* responsible?
Perhaps TheoraJones ( the quote above) would also like to legislate food. It is at least as important as healthcare, isn't it? That's right, the government should be responsible for making sure that you have food. Whoa, let's not forget water....and of course sex. Sex is important to be healthy, isn't it? So now the government is responsible for your healthcare, your food, your water and making sure that you get laid regularly.
Marx and Engel would be proud of her efforts.

Posted by: Fred Jones | Aug 26, 2005 6:55:09 PM

Um, 1 year is a trend?

No question we need to figure out a way to deliver universal health care, but single payer just ain't gonna cut it.

Nor will doing what Canada does, funding health care on the backs of doctors. The fact that a doctor makes twice as much here is a crime.

Of course Canadians love their health care system! The doctors are bearing a large part of the burden! It's always easy to like it when other people are paying for it.

Posted by: Adam Herman | Aug 27, 2005 7:29:51 AM

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