Against CanadaCare

As Matt alludes to here, international comparisons are a little tricky. But he's wrong to defend Canada's health care system. Now, it is true that Americans spend way more on health care, per capita, than other countries do. Taking the Canada example, our neighbors up north spend $2,535 per citizen. We spend $4,631. And the difference isn't in utilization: Americans pay much more for the same services as other countries do (the importance of this point, by the way, cannot be overstated, it's the primary reason our health care costs so much. Countries that bargain as a whole get far lower prices. It's exactly what Wal-Mart does. America, by contrast, has a bunch of mom-and-pop stores doing health care purchasing, and we pay the premiums because, in that system, suppliers have all the power). Presumably, given Canada's lower prices, if they wanted to match our spending and sink in another $1,900 or so per citizen, they could buy a lot more MRI machines, and probably make hospital food into haute cuisine to boot.

That said, Matt's wrong to hold Canada up as any sort of example. When the WHO ranked health systems, we came in 37th, they came in 30th. That we're truly terrible doesn't change the fact that Canada gets far worse health care than other nations do for the same price. Making America your benchmark is like recruiting for your beauty pageant at fat camp: it makes winning easier, but it doesn't mean you're the best. We can compare Canada to its competitors -- just as we can compare America to its competitors -- and see that, objectively, they get worse outcomes for their money. Canada offers mediocre care on their own terms, decent on ours, and poor on France's. Moving to their quality level wouldn't be worth the disruption.

Further, Canada's system is weirdly limiting and, for us, downright dangerous. Unlike, say, France, where private insurance has a secondary role, Canada allows for no entrance of private money into the system. Unlike other countries that guarantee floor coverage for all but allows those with more discretionary income to decide their own ceiling, Canada sets both the floor and the ceiling, capping the conceivable quality of care (they've instituted the old adage about socialism: everyone suffers together).

In addition to being a strange place to bar private spending (what could possibly be a more logical use of extra cash than better health care?), this has the secondary impact of reducing innovation and the entrance of new technologies. Since the only game in town is the Canadian government and they're markedly cautious, there's no space for the cutting edge to flourish, no way for new technologies to rapidly burst into the market. Given the size, wealth, and ingenuity of the American health care sector, a similar situation, transposed here, would be genuinely catastrophic for the speed of health care innovation, hurting both us and the world. A French style system would not bring the same problems.