America's Healthcare System is not Cruel
America's healthcare system debate attracts international attention. Up in Canada, where socialized medicine is the law of the land, the Canadian media enjoy watching the show south of the border. The problem is that the Canadian characterizations are often superficial and erroneous, leaving those outside the United States with an incorrect impression of its healthcare system's performance.
In a recent opinion piece entitled "America's cruel healthcare system, and the GOP's cynical efforts to preserve it" from one of Canada's major daily newspapers, the National Post, Jonathan Kay claims the following:
"Isolated tragedies notwithstanding, lifespans in Canada are actually longer, and our rates of childhood mortality lower, than those in the United States."
Ah yes, "America's cruel healthcare system." Time, once again, to examine reality in detail, since it appears commentators from the mainstream media are generally incapable of presenting the whole picture to their readers. Maybe hyperbole (such as Conrad Black's claims that "[o]ne hundred million Americans have inadequate health care for citizens of a rich country") gets more page views and advertising revenues, but it does little for rational policy making.
The only health statistics Kay cites as evidence are lifespans and childhood mortality rates. Note that Kay doesn't provide serious numbers. Rarely do we see actual data in the Canadian media, and given the rhetoric Kay employs, one would expect dramatic health statistics differences between the two nations. Such is -- unsurprisingly -- not the case. Indeed, as we'll see, the current (i.e., pre-ObamaCare) American healthcare system probably outperforms its Canadian socialized (ObamaCare-wannabe) counterpart.
Starting with Kay's claims of longer lifespans in Canada and lower rates of childhood mortality, this is unequivocal cherry picking of data -- since only two statistics do not make a rigorous health-care system comparison. Regardless, the lifespan comparison issue has been previously addressed by conservative commentators, and the results do not come out in Kay's favor.
As both Ethel Fenig and Matt Palumbo have previously discussed on American Thinker, lifespan statistics are effectively useless for comparing the capabilities of health-care systems. Life expectancy data integrates many lifestyle and socioeconomic factors beyond the health-care system, such as rates of murder, suicide, obesity, and other dietary choices, smoking, alcohol and drug consumption, traffic accidents, geographic factors, and on the list goes. When some of these other factors are accounted for, yielding what is termed the standardized mean life expectancy (without fatal injuries), Scott Atlas -- a senior fellow at the Hoover Institution and professor of radiology and chief of neuroradiology at the Stanford University Medical Center -- showed that the USA actually has the highest life expectancy, beating out Canada by almost a full year. Atlas makes a sufficiently strong and disturbing case against the World Health Organization's World Health Report 2000 -- the report that is often used as justifying ObamaCare -- that this WHO report should be formally retracted, and all funding for the WHO cut off.
Rick Moran has dealt with the infant mortality statistics red herring on AT as well. Quite simply, various nations define infant mortality in differing ways, making a direct comparison of the statistics nonsensical.
In their 2008 study considering health status, health care, and inequality between the American and Canadian systems, June and Dave O'Neill from Baruch College reached similar conclusions as discussed above about the spurious use of life expectancy and infant mortality data when comparing these two health-care approaches, showing that the premises behind Kay's claims for a "cruel" American health care system are unfounded. The O'Neill's also found the following important points:
• While there is a modestly higher incidence of chronic health conditions in the USA than in Canada -- not necessarily a reflection of the healthcare system efficacy, there is greater American access to treatment for these conditions.
• The health-income gradient is actually steeper in Canada than the USA. One of the benefits anticipated from a single-payer system (such as in Canada) is a more equitable distribution of health resources and health outcomes than would occur in a system where access partly depends on ability to pay. The data do not support such expectations.
• More Americans than Canadians answered "fully satisfied" and "excellent" when asked about satisfaction with health services and the ranking of the quality of services recently received.
• There is either no difference in self-perceived health status between the two countries, or even a slight indication of a higher percentage reporting excellent health in the USA.
• The longer waiting times in the Canadian system are having more adverse effects on well-being than in the USA. Unmet healthcare needs in general are having more negative health impacts in Canada.
• The USA has a much higher rate of using early detection testing systems. This appears to be paying off, as the American performance for detecting and treating cancer is superior to that of Canada.
• American respondents gave much higher ratings to the quality of care received, and were more satisfied with health-care services received, than were the Canadians.
An OECD report comparing health-care performance among its member states provides perhaps the strongest evidence that the Canadian system is potentially inferior to that of the USA. While mortality rates for ischemic heart disease and stroke are about equal in the two nations, the USA has lower mortality rates for all cancers, and particularly lung, breast, and prostate cancer. The USA (at 90.0%) leads all countries considered in the percentage of adults reporting to be in good health.
Both the USA and Canada have equivalent numbers of practicing doctors normalized to population, but the USA has twice the density of gynaecologists and obstetricians, and more practicing nurses per citizen, than Canada. In-hospital case-fatality rates within 30 days after admission for ischemic stroke are more than twice as high in Canada compared to the USA. The rates of a foreign body left in during a procedure are also twice as high in Canada, and rates of accidental puncture or laceration are greater than three times the American rate (Canada leads all nations in this unfortunate statistic). Colorectal cancer five-year relative survival rates are higher in the USA.
Given the socialized nature of its medical system, one would expect out-of-pocket expenditures as a share of final household consumption to be much lower in Canada than the USA. They are not. The USA is at 3.1%; Canada is nearly equivalent at 2.9%.
The socialized Canadian system would also lead us to expect a better performance for lower income groups on health screening activities. Such is not the case. The USA performs better than Canada for cervical and breast cancer screening at all income levels -- including low income individuals.
When it comes to waiting times, Canada is notoriously bad (and as noted above, these long wait times are having significantly higher adverse health impacts than we see in the American system). The number of patients reporting a waiting time of four weeks or more for a specialist appointment? Canada is at 60%. The USA is down at 20%. The number of patients reporting a waiting time of four months or more for elective surgery? Canada is at 25%. The USA is at 7%.
Health is integrative over an individual's lifetime, and individuals living in a higher quality healthcare environment would be expected to report better health late in life. On this note, the percentage of the population aged 65 years and over reporting to be in good health is higher in the USA than Canada.
The United Nations/World Health Organization database also provides some interesting data. When compared to Canada, the USA has a higher density of dentistry personnel, a superior diphtheria tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds, a greater than six-fold higher Hepatitis B (HepB3) immunization coverage rate among 1-year-olds, an equivalent rate of Hib (Hib3) immunization coverage among 1-year-olds, a much higher rate of DPT immunization for children aged 12-23 months, and an equivalent measles (MCV) immunization coverage among 1-year-olds. Rates of cholera, measles, mumps, pertussis, tuberculosis, and tetanus are lower in the USA than Canada, with an approximately equivalent rate of rubella.
As I've noted already, it's not only difficult for a Canadian such as Kay to claim that America has a "cruel healthcare system," he may need to accept that the Canadian system may be substantially inferior to -- and therefore much crueler than -- its American foil. Rather than the Canadian system being a rationale for implementing ObamaCare, the data suggests the Canadian system should instead be reformed to model the pre-ObamaCare American model.