The misinformation campaign about Canadian healthcare

Hi, this is Matthew Holt from The Health Care Blog, and I'll be writing a few articles about health care, (which may be somewhat crossposted from my blog) and taking the odd rare opportunity to rant about other subjects of my choosing here too. I will (as instructed by Ezra) be writing later in the week about what really happened to the Clinton's failed health care plan, and what lessons that brings for reform when we next get a chance.

But first I must get at one of my pet peeves, as it came up again this past week.  And that peeve is the situation that allows a combination of fact cherry picking and straight out lies to be told about other nation's health care systems. You all probably know the real story. Basically every other country figured out its way to some level of universal insurance system, with a mix of public and private provision of health care, with usually a centralized budget making sure that the health care monster didn't overwhelm the rest of the economy. Between the early years of the 20th century and 1970 when the Canadians moved to their single payer system, every other nation figured out that putting everyone in a single risk pool enabled both greater (if not complete) equity in health care access, and also the ability to contain the overall costs in the system.

The USA never got to that point for a variety of political reasons that I won't spell out but involve a mixture of special interests and jingoistic politics. And every time something goes wrong with our system and Canada is cited as perhaps being an alternative to look at (even if it's not as appropriate a model for the US as France, Germany, Holland or Japan), a strange sub-sect of the VRWC comes out of the gutter and makes its way onto the nation's op-ed pages. The aim is of course to stop any rational debate about what we ought to replace our provider and insurer-driven system with.

I had hoped that when the Boston Globe gave Jeff Jacoby a chance to rant about Canada and single payer, and THCB was able to call bullshit, that I wouldn't have to repeat myself quite so soon. But to no avail. The Chicago Tribune gives a columnist called Steve Chapman, who incredibly enough worked for the liberal  New Republic (although aside of that has a long list of writing for libertarian and conservative newspapers), a chance to spread way more disinformation.

It's good to know that a serious newspaper can allow a leading columnist to write about Canadian health care using numbers about the length of Canadian waiting lists from hopelessly biased organizations like Fraser and Cato, but ignore the official statistics which indicate that Fraser is wrong on waiting lists by a factor of 4. And for that matter the average waiting lists quoted by Fraser of around 4 months for elective surgery aren't that bad--yet somehow Chapman starts talking about two year waiting list because one orthopedic surgeon said so.

Chapman then goes on to cherry-pick different outcomes on cancer to show that American care is better. Of course he doesn't bother looking at overall care in different countries. This article in Health Affairs did just that (and is one in a series). The result, as again commented on in THCB, is that overall there is no real advantage to being in America. We do worse on somethings and better on others, but the suggestion by the Canada bashers that we get what we pay for is well off-base. And we clearly pay a lot more than anyone else and the share of those costs borne directly by poorer Americans is much, much greater than that borne by poor Canadians (or poorer people in other nations).

And if you look at the Health Affairs study a little more carefully you come to the authors' conclusions.  Remember this is a real academic peer reviewed study, not some rubbish that Fraser Institute made up to suit its political agenda.  Here are the conclusions:

Across multiple dimensions of care, the United States stands out for its relatively poor performance. With the exception of preventive measures, the U.S. primary care system ranked either last or significantly lower than the leaders on almost all dimensions of patient-centered care: access, coordination, and physician-patient experiences. These findings stand in stark contrast to U.S. spending rates that outstrip those of the rest of the world. The performance in other countries indicates that it is possible to do better.

There's plenty wrong with Canadian health care--something I looked at in depth in my "Oh Canada" piece. I'm also pretty sure that it's not a good model for America, whereas Germany, Holland, France or Japan might well be.  But I really wish that if right-wing know-nothing columnists are going to write about this subject, that they'd either learn something about it themselves, or try to abstain from feeding at the research trough of totally biased organizations like Cato and Fraser. I suspect though that I'll be wishing in vain for a while, but shouldn't the Chicago Tribune hold itself to a higher standard?

- Matthew Holt