[Peace-discuss] Oh, Canada!

[C. G. Estabrook]

[We had some disobliging things to say about Canada on News from Neptune (UPTV 
ch. 6, 7-8pm and soon on <www.newsfromneptune.com>) tonight, but -- to show 
we're fair and balanced -- nota bene, below.  --CGE]

	Canadian Health Care, Even With Queues, Bests U.S.
	By Pat Wechsler
	Sept. 18 (Bloomberg)

Opponents of overhauling U.S. health care argue that Canada shows what happens 
when government gets involved in medicine, saying the country is plagued by 
inferior treatment, rationing and months-long queues.

The allegations are wrong by almost every measure, according to research by the 
Organization for Economic Cooperation and Development and other independent 
studies published during the past five years. While delays do occur for 
non-emergency procedures, data indicate that Canada’s system of universal health 
coverage provides care as good as in the U.S., at a cost 47 percent less for 
each person.

“There is an image of Canadians flooding across the border to get care,” said 
Donald Berwick, a Harvard University health- policy specialist and pediatrician 
who heads the Boston-based nonprofit Institute for Healthcare Improvement. 
“That’s just not the case. The public in Canada is far more satisfied with the 
system than they are in the U.S. and health care is at least as good, with much 
more contained costs.”

Canadians live two to three years longer than Americans and are as likely to 
survive heart attacks, childhood leukemia, and breast and cervical cancer, 
according to the OECD, the Paris- based coalition of 30 industrialized nations.

Deaths considered preventable through health care are less frequent in Canada 
than in the U.S., according to a January 2008 report in the journal Health 
Affairs. In the study by British researchers, Canada placed sixth among 19 
countries surveyed, with 77 deaths for every 100,000 people. That compared with 
the last-place finish of the U.S., with 110 deaths.

Infant Mortality

The Canadian mortality rate from asthma is one quarter of the U.S.’s, and the 
infant mortality rate is 34 percent lower, OECD data show. People in Canada are 
also 21 percent more apt to survive five years after a liver transplant.

Yet the Canadian “bogeyman,” as U.S. President Barack Obama called it at an Aug. 
11 gathering in Portsmouth, New Hampshire, may have “all but defeated” the idea 
of a public option in the U.S., said Uwe Reinhardt, a health-care economist at 
Princeton University in Princeton, New Jersey.

Senate Finance Committee Chairman Max Baucus, Democrat from Montana, introduced 
on Sept. 16 compromise health-care legislation that, unlike other House and 
Senate bills, omits a government-backed choice for the uninsured living in the 
U.S. who can’t afford private coverage.

Insurance Mandate

Private insurers, the pharmaceutical industry and the medical profession fear 
the “market power” of a public plan, Reinhardt said. They “deployed certain 
think tanks to find horror stories around the world that can be used to persuade 
Americans a public health plan in the U.S. would bring rationing.”

Given that Congress is likely to pass a mandate to cover the uninsured, 
Americans forced to buy policies will be left with no alternative to coping with 
“double-digit rate increases” on commercial premiums, Reinhardt said.

“Both systems ration medical care,” he said. “In Canada, they make people wait. 
In the U.S., we make people pay.”

Fifty-four percent of chronically ill Americans reported skipping a test or 
treatment, neglecting to go to a doctor when sick, or failing to fill a 
prescription because of the cost, according to a 2008 survey by the Commonwealth 
Fund, a foundation that focuses on health care, and pollster Harris Interactive. 
That was more than twice the number in Canada, data from those New York-based 
groups showed.

Payment Worries

As the price of health care in the U.S. has risen three to four times faster 
than the rate of inflation, surveys show that Americans have become concerned 
they won’t be able to pay medical bills. Forty-three percent of consumers in a 
June poll by the University of Michigan in Ann Arbor said they worried they 
might not be able to afford care, even with insurance.

“Canadians value fairness, and they cannot conceive of a system in which someone 
can’t get health care,” said Wendy Levinson, a Canadian who runs the department 
of medicine at the University of Toronto and worked in the U.S. from 1979 to 2001.

The U.S. spent $7,290 on health care for each person in 2007, 87 percent more 
than Canada’s $3,895, according to the latest OECD data. The U.S. also devoted 
the highest percentage of gross domestic product to health care, 16 percent, 
OECD numbers show. Canada’s expenditure was 10.1 percent.

Canada’s system consists of 10 provincial and three territorial nonprofit 
insurance plans that cover all citizens, including those with pre-existing 
conditions. It operates like Medicare, the U.S. program for the elderly and 
disabled. In Canada, the government uses taxpayer funds to pay claims by 
doctors, who mostly work in private practice or for a hospital and are paid fees 
for their services.

Effect of Technology

Care is free where it’s provided, as in a doctor’s office, except for dentistry, 
nursing home stays, prescription drugs outside hospitals, and rehabilitation 
services. The elderly and low-income residents get help with pharmaceutical 
purchases.

Technology partly explains the cost discrepancy between the two nations. There 
are 67 percent more coronary-bypass procedures in the U.S. than in Canada and 18 
percent more Caesarean sections, OECD data show. In 2006, the U.S. had more than 
four times the number of magnetic resonance imaging units - - 26.5 for every 
million residents compared with 6.2 for every million in Canada -- making 
Americans three times more likely than Canadians to get a scan, according to the 
OECD.

In the U.S., technology is “overused” because doctors have to justify equipment 
purchases with revenue, according to Gerard Anderson, a professor of public 
health and medicine at Johns Hopkins University in Baltimore. Canada in the 
1960s was about as expensive as the U.S., he said.

No. 1 in Cost

“The real difference has been their ability to control technology costs,” said 
Anderson, who directed reviews of health systems for the World Bank and 
developed U.S. Medicare payment guidelines for the Health and Human Services 
Department. “The only thing the U.S. is consistently No. 1 in when it comes to 
international comparisons with Canada and other OECD countries is cost.”

Less technology and, according to a 2007 report from the World Health 
Organization, 20 percent fewer doctors in Canada than in the U.S. have led to 
longer lines north of the border.

In 2008, 20 percent of chronically ill Canadians surveyed by the Commonwealth 
Fund reported waiting three months or more to see a specialist. Five percent of 
Americans polled said they had to wait that long.

Television Commercial

Washington-based lobbying groups including Americans for Prosperity and 
FreedomWorks have seized upon the delays, arguing that Obama’s proposal for a 
public option would eventually put private insurers out of business and force 
everyone to live with government-paid coverage and substandard care. 
FreedomWorks is led by Dick Armey, a former Republican congressman from Texas.

An educational foundation affiliated with Americans for Prosperity paid $3.3 
million to run a 60-second television commercial on U.S. stations in which Shona 
Holmes, a 45-year-old native of Waterdown, Ontario, accused the Canadian 
health-care system of almost causing her to die by delaying critical treatment, 
according to Amy Menefee, a spokeswoman for the foundation. The ad ran for three 
weeks and was repeated on Sept. 9 after the president’s speech.

The TV spot first aired in May. Holmes, a mother of two and a self-employed 
family mediator, said in the ad that she went to the U.S. for care. She traveled 
2,237 miles (3,599 kilometers) to the Mayo Clinic in Scottsdale, Arizona, and 
spent $97,000 for treatment of a benign brain tumor rather than wait for 
insurance-paid care in Canada, she said in a telephone interview.

Bridge to Canada

“I felt strongly I could speak out because I’ve seen both systems,” Holmes said. 
“I have seen how government involvement plays very negatively.”

Obama administration officials are trying to use the public option as “a bridge” 
to a system like Canada’s since “they realize it isn’t politically acceptable to 
go directly to that,” said Phil Kerpen, the director of policy for Americans for 
Prosperity.

In Ontario, where Holmes lives, the average waiting time for surgery to remove a 
tumor was 99 days in the second quarter, according to the Ontario Health 
Insurance Plan’s Web site. If a patient was willing to go closer to Ottawa, the 
wait was 36 days at Pembroke Regional Hospital Inc. in Pembroke, 460 miles from 
Waterdown and 93 miles northwest of the Canadian capital. Closer to Waterdown, a 
patient could go to St. Joseph’s Healthcare Hamilton, less than 10 miles away, 
with a 56-day wait.

Ontario Appeal

Holmes began speaking out publicly, she said, after she couldn’t get Ontario in 
July 2005 to speed removal of her craniopharyngioma, a type of slow-growing 
cystic tumor that can put pressure on the brain or optic nerve. She is now 
pushing for the province’s insurance plan to reimburse her for the money she 
spent on surgery, tests and follow-up, she said in the interview.

Andrew Morrison, a spokesman for the Ontario plan, said Canadians need approval 
before getting care outside the country if they want to be reimbursed. He 
declined to comment on the Holmes case. Lori Coleman, registrar for the 
Toronto-based Health Services Appeal and Review Board, which handles complaints 
about the Ontario plan’s eligibility and payment decisions, also declined to 
comment.

Even with the waits, a majority of Canadians balk at the idea of turning 
government insurance over to private hands. In a July Harris/Decima poll, 55 
percent of respondents said improvement should be made through the public plan, 
while 12 percent favored a private solution.

Doctor Visits

In both the U.S. and Canada, 26 percent of people interviewed told the 
Commonwealth Fund survey of chronically ill adults they got a same-day 
appointment with a doctor when they were sick -- the lowest number in any of the 
eight countries polled by the foundation. Thirty-four percent of the Canadians 
said they had to wait six days or more, compared with 23 percent of the Americans.

Canadians visited their doctors more frequently: 5.9 visits per person compared 
with four for those in the U.S., according to 2005 OECD data.

The U.S. leads industrial countries in the portion of the health-care dollar 
devoted to processing claims and paying providers, the Commonwealth Fund said.

Private-insurance administrative costs in the U.S. are 12.7 cents of a dollar, 
and as high as 18 cents for some companies, said Karen Davis, president of the 
Commonwealth Fund. Government plans, including Medicare and Medicaid, spend 5.8 
cents excluding costs of private drug plans, she said. In Canada 4.2 cents is 
spent on administration.

“If we lowered our administrative costs to that of the lowest three countries 
with mixed public-private health-care systems, we could save $50 billion a 
year,” Davis said. “This would go a long way toward financing coverage for the 
uninsured.”

To contact the reporter on this story: Pat Wechsler in New York at 
pwechsler at bloomberg.net
Last Updated: September 18, 2009 12:22 EDT

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