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Monday, 17 April 2006
Canada, they hardly know ye
Topic: economy
As soon as I saw Dr. Peter Mott's April 12 D&C op-ed on single-payer health insurance, I knew some MD out there would lob a grenade, live or otherwise.

And sure enough, just five days later, a dud from a Brighton MD landed on the D&C letters page. The doc warned against a Canadian-style single-payer plan, which he claimed "lacks the capacity to provide needed care in a timely manner." He played a slight variation on the orthodox tune: Canadians flock to US hospitals to get care they're denied at home because of long queues and sparse equipment - a situation Americans would never tolerate.

But then the doc tipped his hand.

Shockingly, he suggested that "the solutions to our problems lie in reaching agreement [about] whether we value committing scarce resources to extending the lives of our extreme elderly and those with chronic diseases."

Whoa. And ouch. I thought we had a durable agreement to give care as needed to prolong life and ease suffering. Or at least we held up something like this as an ideal. But was this doctor actually arguing for a form of human sacrifice? Did he mean to endorse a regime of cost-driven triage that would throw the oldest people (age cutoff presumably to be determined by accountants) in the dumpster, and push the chronically ill to the margins?

I hope the argument was nothing more than a D&C editing error, or someone letting his words get away from him. But let's get real: The sort of triage the letter implicitly supported is already common practice. And this might explain in part why the US has such dismal health stats - much worse than Canada's, no matter what the orthodox professionals here would have you believe.

Compare some figures drawn from World Health Organization data bases:

Infant mortality ratio: Canada, 5.1 per 1,000 live births; US, 7.2

Maternal mortality ratio: Canada, 5 per 100,000 live births; US, 14

HIV prevalence, 15-to-49 year olds: Canada, 0.3 percent; US, 0.6 percent

Life expectancy at birth, total pop.: Canada, 80 years; US, 77 years
--- males: Canada, 78 years; US, 75 years
--- females: Canada, 82 years; US, 80 years

Healthy life expectancy at birth. total pop.: Canada, 72 years; US, 69.3 years

Per capita Gross National Income (US dollars): Canada, $23,930; US, $37,600

Per capita health spending (US dollars): Canada, $2,222; US, $5,274

Looking at any or all of these figures, you can't help but conclude the Canadians, who on average aren't as rich as Americans, are doing it better and smarter.

Our neighbors across the lake aren't blind to their
system's shortcomings, either. Recently, the Council of Canadians published an update on health care that acknowledges some problems with their national single-payer system but also - contrary to the practice of stateside critics - shows where the true remedies are to be found. On the matter of queues (wait-times), the Council laid major blame on "a serious shortage of health care providers," and in turn, on health-care funding shortfalls that will require tens of billions in new spending.

In short, the Canadian single-payer system is flawed only to the extent it has been starved of money. As you can see from the WHO figures above, Canada spends half of what the US spends on health per person. If its annual expenditure per capita went up significantly, Canada could easily fix the problems dogging its health system - problems which in any case don't prevent superior national health outcomes.

The bottom line for the US is this: If we went single-payer, we could spend much less per capita and get a lot more health for our buck. And we wouldn't have to set the old folks out on the ice floe.

Posted by jackbradiganspula at 15:58 EDT
Updated: Tuesday, 18 April 2006 02:19 EDT
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