Friday, April 18, 2014

You Say You Want Single-Payer Health Care

O, Canada!

If Obamacare was always meant to be a leap toward a single payer health care system, we are certainly within our rights to examine how well the system is working in… for example… Canada. 

Since Canada is an advanced industrial democracy, comparing us to them is certainly reasonable.

So says, Sally Pipes this morning. Having studied the Canadian system in depth, she draws some harsh conclusions:

Single-payer’s cheerleaders cite Canada as proof of the system’s superiority. It’s a foolish fetish: Our northern neighbor’s health-care system is plagued by rationing, long waits, poor-quality care, scarcities of vital medical technologies and unsustainable costs. That’s exactly what’s in store for America if we follow Canada’s lead.

Rationing means that needed care is unavailable to all but those who can pay for it out of pocket… presumably, by traveling to the United States. 

Pipes explains:

To keep a lid on costs, Canadian officials ration care. As a result, the average Canadian has to wait 4½ months between getting a referral from his primary-care physician to a specialist for elective medical treatment — and actually receiving it.

Mind you, “elective treatment” in Canada doesn’t mean Botox or a tummy tuck. We’re talking about life-or-death procedures like neurosurgery, orthopedic surgery or cardiovascular surgery.

Of course, some American states adopted Obamacare before the others. Take Massachusetts, where they call it Romneycare:

Bostonians face the longest wait times for an appointment in America, according to Merritt Hawkins, a consultancy. That’s no surprise, given that Massachusetts essentially enacted ObamaCare in 2006, four years before it went national. Even so, the average wait in Boston is 45.4 days — about three months less than in Canada.

Obviously, anyone who thought that the best way to defeat President Obama was to run a candidate who had implemented the predecessor of Obamacare in Massachusetts was wrong. Mitt Romney would do the Republican Party an enormous favor by retiring from the political scene.

But, going back to Canada, that very wealthy nation promises a lot more care than it can provide. Because, a system run by government bureaucrats is markedly inefficient:

There’s also a severe shortage of essential medical equipment. Canada ranks 14th among 22 OECD countries in MRI machines per million people, with an average wait time to use one at just over eight weeks. Canada ranks a dismal 16th in CT scanners per million people, with an average wait time of over 3.6 weeks.

The United States ranks second in MRI machines per-capita, and fifth in CTs.

Every Canadian is technically “guaranteed” access to health care. But long waits and the scarce resources leave many untreated.

Speaking of inefficiency, when people cannot receive needed treatment promptly, their conditions get worse. This means that they will need “more expensive and extensive treatments.”

Pipes writes:

When people aren’t treated in a timely fashion, their conditions worsen, which often means significantly more expensive and extensive treatments. The Center for Spatial Economics, a Canadian research outfit, estimates that wait times for just four key procedures — MRI scans and surgeries for joint replacement, cataracts and coronary-artery-bypass grafts — cost Canadian patients $14.8 billion a year in excess medical costs and lost productivity.

As for the cost, Canadians pay for it through taxes. Naturally, this does not apply to the people who do not pay taxes. In America, most of that cohort votes Democratic.

If you think that your insurance premiums are high, look at how much you would be paying in taxes to get Canadian-style substandard, rationed treatment:

Nor is Canadians’ treatment close to “free”: Patients may only have to pay a nominal fee when they get treatment. But the typical Canadian family pays about $11,300 in taxes every year to finance the public-insurance system.


Dennis said...

I would suggest that the only reason the Canadian system operates at all is that most Canadians can cross into the US and get healthcare provided in a timely fashion. Living in Florida I see a large number of "snowbird" Canadians who utilize our slowly degrading healthcare services.

Lastango said...

The Brit are an even more dramatic example of rationing. Yes, there is free health care for everyone. No, you can't actually access it. The ability of Brits to band together to defend their cherished system is a triumph of rhetoric over reality.

As Dennis points out, large numbers of Canadians receive health care in the US. Many of these are sent south by the health care system itself, and there is a significant network of clinics and other facilities in the northern states catering to this market. Canadians have yet to muster the political will to truly face the need for private-sector health care. One of the ways they lie to themselves is to deny the need for that while shipping their patients to the private facilities in the US. That way they can maintain the fiction that government-sourced care is adequate. This is rarely discussed, and Canadian governments (and their countless dependents, bought friends, and getaway drivers in the media) downplay problems.

But the situation in Canada is getting worse fast as costs rise and the population ages. De facto rationing as unspoken policy will become the norm -- as it long has been in the UK -- unless Canadians face up to the need to make hard choices.

Anonymous said...

Thank you for the article, Stuart. Having lived in England for almost a decade I always roll my eyes when liberals tell me about the wonders of the NHS. They, of course, only took a two-week vacation to London and already know everything.

Speaking of know-it-alls, I think that you would like this article on what is happening in world of debate competitions:

No wonder we are in trouble...

n.n said...
This comment has been removed by the author.
n.n said...

I have read that the French medical insurance system works similar to our Medicare (~80% coverage). It is "single"-payer, but the patient is first-payer, and the government reimburses qualified expenses.

From my perspective, the issue is first to provide quality service, second to mitigate corruption, and third to avoid stifling innovation.

I think the problem in America is two-fold. One, there exist structural disparities, most notably in high density population centers, and forcefully integrated economic classes. Two, there are a "vast number of conditions" which distort our market economy and drive progressive inflation, despite significant and ongoing technological and productivity improvements.

Anonymous said...

You would be surprised at the number of Canadian license plates in the parking lots of major hospitals here in Metro Detroit. It's remarkable. People don't travel to other countries because they receive superior healthcare at home. Why go out for hamburger when there's steak at home? People don't want to wait 8 months for their steak to arrive.

I remember the Opening Ceremonies at the 2012 London Olympics had a segment, or float, or whatever production piece on the National Health Service. It had kids jumping up and down and doing aerial somersaults from these beds rigged with trampolines. It was to show what an amazingly delightful thing the NHS is, and how proud of it they are. I found it remarkably odd. I've never seen a country put on such a spectacle celebrating a government agency. You'd almost think that Brits are eager to pay taxes because they get such a tremendous value from NHS. We know this isn't true.

What is the world going to do when it can no longer get a free ride on American medical innovation? And when, oh when, are we going to see some reining-in of lawyers and medical malpractice? When? I heard yesterday that malpractice insurance for an OB/GYN in Virginia/DC is $176,000 per year. Per year! That is insane. Not one word about tort reform in ObamaCare.


Larry Sheldon said...

I got a referral for a problem the GP couldn't deal with--I decided I didn't like any of the probable options and deliberately did not follow up.....

A day or two ago the referred-to office called.

Anonymous said...

US drug companies sell them cheap drugs while overcharging Americans.

Dr. Mabuse said...

It's all perfectly true. My daughter began having nighttime seizures at the age of 16. Our GP referred her to a neurologist. Our appointment to see him was 8 months away. Eight months. And she kept having seizures the whole time. When we finally saw him, he was a great doctor, and quickly diagnosed her as having epilepsy, which has been easily controlled in the following 8 years with medication. But that's what our medical system is like.

Oh, and we're not in some Prairie village, either. We live in Ottawa, the nation's capital. If our politicians had any brains, they'd begin dismantling the idiotic centralized system right now, to scoop up the American doctors who'll be fleeing Obamacare very shortly. Our medical woes would be a thing of the past.

Anonymous said...

Dr. Mabuse:

Politicians don't have brains. They have egos and friends to take care of, not my nor your interests. This is not one man's cynical opinion, but a part of humanity. Politicians are the same the world over. They don't listen, they just do whatever's required to stay in office and take care of themselves. The U.S. Founding Fathers set up a balanced system that took power dynamics into account. Now that avarice is acceptable, fashionable, and expected, there is no check on federal power. Washington, D.C. is hopelessly decadent so long as they can keep placating the ever-increasing proportion of "takers" with more goodies. Don't know if it's as bad in Ottawa.

Good idea for the Canadian doctor recruitment strategy in the wake of American stupidity. Here's the new slogan for the next AMA ad: "It's better up here than it is down there!"


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