Health Care and Inequality: Canada vs United States

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http://www.bepress.com/fhep/10/1/3/?sending=10252

It depends on what criteria you're judging it on. America has better quality of care, while Canada has easier access to care.

I said Canada has the better system because you can get access. Here in the US there is usually a significant wait to visit a specialist, at least in my experience. When I started showing symptoms of arthritis, I had an appointment with a general practice doctor fairly quickly, but I had to wait 4 months to go see a rheumatologist.

That meant 4 months of chronic pain, because the first doctor wouldn't prescribe anything. Even after the first visit, it took almost another month to get started on anti-inflammatories (the pharmacy had to order the medicine for me only). Now, 7 months later, I have tried only 2 different medicines out of about 10 available. One works, but not well enough, the other works well but is unusable in the long-term. And the doctors are still not sure what I have exactly, all the suspect conditions are treated in the same way, fortunately.

In my case at least, access is more important than quality, as long as we are only comparing Canada and the US. (I think Canada is near the US in terms of quality anyway).

By easier access, I didn't mean anything about waiting times. These are far worse in Canada than in the US, Balefire. I just meant that it's free in Canada. (Well, not really. You pay for it, but indirectly.)

Orwell, I have become somewhat interested in Libertarianism as of recently from both a social and economic standpoint. Most of the info I've read about the free healthcare debate in the United States is somewhat biased towards the socialized standpoint. I know the basic stuff like how taxes obviously have to be raised and the quality of health care may be diminished if it were universal, but I'm somewhat ignorant on the issue as a whole. I don't mean to be a pain in the ass, but I know you oppose universal health care and know quite a bit about Libertarianism, do you have any good resources supporting the privatized side of this issue that I could check out?

Hard to imagine longer waiting times than here. Although if a Department of Motor Vehicles-style bureaucracy ran a doctor's office, I would expect no less. Silly me, thinking a massive governmental healthcare system could ever be faster than a privately run one.

However, the access issue is still relevant because I will have a hard time getting coverage. Most insurance companies won't want to take a young person who already has one or possibly two chronic diseas(es) that will probably require surgical intervention. Not to mention the fact that I take a lot of expensive medicines.

I read a study a while back comparing quality of healthcare between the US and various socialized systems that I'll try to dig out. A few points I remember from it off the top of my head: cancer mortality rates are MUCH better in the US than in Europe. Infant mortality rate statistics are unreliable for comparison because not all countries tabulate them in the same manner (in many European countries, a baby born under a certain weight/size doesn't count in those statistics if it dies, but any baby does count if born in a US hospital) and as far as life expectancy, after you control for things like accidents and homicides (which have nothing to do with the quality of the medical system) the US actually comes out with a higher life expectancy than many other countries often touted as superior for their medical care, despite the fact that Americans lead much less healthy lifestyles- meaning our medical care is so good that it can compensate for many of our citizens not taking care of themselves and still get better results than socialized systems.

And then there's just the fact that our government fails at most of what it attempts. I don't want USPs-style service from hospitals. Decentralized systems are better at handling problems quickly and efficiently because they don't have to jump through bureaucratic hoops. No matter how efficient you try to make it, a centralized system is just too unwieldy and inflexible to deal as effectively with the needs of individual patients the way a more privatized system can.

Lastly, there isn't a need for such radical change in our system. It has flaws, yes, and we should work on improving it, but the solution to what are relatively minor problems should not be to scrap the system we have and institute a command economy in the healthcare sector.

I'll try to dig out some concrete sources for you later, but now it's suppertime. Oh, and no one bother bringing up the fat man and his "documentaries"- there is just waaay to much low-hanging fruit to tear apart in those propaganda pieces.

A minister who visited my church once mentioned a trip to France where he had a heart attack or something and the doctors at the emergency room told him "If you don't get into surgery right NOW, you will die." Then he had to wait about six hours.


The coverage issue seems to be the only legitimate gripe people have with our current system, and I think there are easier ways to remedy this than going for all-out socialism.

That's depressing, I wonder if the fat man with his propaganda heard that one?

I'm curious, what is the libertarian solution? Deregulation doesn't seem too promising in this case, as people have a hard time finding coverage even when regulation is tilited in their favor, nor lower taxes, because there aren't any industry-specific ones (yet). Although it would help with everyone's health insurance bill if more of us exercised, that won't do anything for the uninsured.

Depends on the libertarian you ask. Some really hard-core libertarians take the view that if you're in that situation, well, you're screwed and that's just too bad, but no one else's problem. Part of the issue is that what's driven up costs has been the regulation that's been added- HMO's were an innovation of the Nixon administration. I could see some form of public subsidies to help people cover insurance costs if they can't afford them. But there's no reason for single-payer socialized health care or centralized control.

Right, one of the health care systems I hear promoted by free market advocates is Singapore's.

http://econlog.econlib.org/archives/200 ... _heal.html

The US doesn't actually have a health care system as far as I can tell. It's more of an industry, a very profitable industry.

Hmm, it might be helpful to insert actual numbers into this debate. Maclean's Magazine had an article on this earlier in July, so I'm going to quote the stats provided in that.

Clearly Sourced Stats

Life expectancy for men
Canada: 77.8 || US: 75.2

Life expectancy for women
Canada: 82.6 || US: 80.4

Infant deaths per 1000 live births
Canada: 5.3 || US: 6.8

% with heart disease
Canada: 5.5 || US: 5.9

% with diabetes
Canada: 4.7 || US: 6.7

% women who are obese
Canada: 19 || US: 33

% men who are obese
Canada: 17 || US: 31

Public and private health care spending per person each year
Canada: US$3,326 || US: US$6,401

Sources:
Life expectancy, infant deaths, obesity, health care costs (all 2005): OCED Health at a Glance 2007;
heart disease and diabetes (2002): "Access to Care, Health Status, and Health Disparities in the United States and Canada," American Journal of Public Health, July 2006


Unclearly Sourced Stats (some parts I have paraphrased):

"A recent Arizona State University study found our (canadian) public education campaigns (emphasis mine), coupled with better quality produce ... have resulted in Canadians devouring twice as many servings of fruits and vegetables per day as our U.S. cousins."

"Harvard Medical School's Dr. Steffie Woolhandler, who co-authored the US verses Canada analysis, says if you only compare Americans who have good health insurance to Canadians, we (Canadians) come out about the same."

% of people who claim to have forgone health care due to cost
Canadians: 12% || Insured Americans: 31% || Uninsured Americans: 68%

"A Commonwealth survey of sicker adults revealed that Canadians are twice as likely to wait four hours or longer in the emergency room then their American counterparts. We (Canadians) also have to wait longer to see our specialists, and we (Canadians) are four times more likely to wait four months or longer for elective or non-emergency surgery such as hip replacements"

Due to long waits, Canadian doctors are more likely to see if the body can mend itself before recommending surgery, and to try alternative medicine. "For instance, if you have back problems in Canada, doctors will try acupuncture, cortisone injections, and physiotherapy before surgery, whereas in America, the operating theatre is often the first stop. But according to a study of back surgeries by the University of Kansas Medican Center, while the Canadian approach is cheaper, it doesn't produce worse long-term results."

About Singapore's health care: it's sad a program that appears to work very well is never discussed, we have either socialized health care (expensive with waiting problems) or essentially what we have now (hideously expensive with relatively quick access to care), according to the two parties in the US. It really is a shame there are only two parties.

What about how bloody expensive it is? My friend got diabetic ketoacidosis in Arizona. How much did they charge him? Over $25,000....

What about the fact that Americans on average pay about twice as much as Canadians, but come out sicker? And even when you just include those who have coverage, they just come out the same health wise despite paying more? The one thing the American system does better is speed at dealing with elective medicine (NOT emergency care, Canadian hospitals still practise triage, I don't know where people get the idea that it doesn't). So yeah, while it sucks that I have to sit in the waiting room longer for non-emergency care, I get the luxury of knowing that I'm guaranteed basic treatment and know overall I'm paying less.