The World's Largest Health Policy Experiment
The title of this blog entry is how Dr. Michael Rachlis, a Canadian physician and health policy analyst, describes the side-by-side comparison of Canadian/American health systems since the 1960's, when the two countries chose different pathways for national health financing. Canada chose to fund health care with provincial health authorities which in turn received significant funds from their national government. The US chose to fund health care for the elderly with 100% federal funding and program oversight, while the very poor received state medical assistance supported by federal funding under national rules. Of course, other persons in the US(not among the very poor or elderly) receive health care funding in variable ways or not at all, depending on their situation.
Dr. Rachlis writes about the different national health policy experience in these two North American neighbors in an op ed piece published in the LA Times (find it here). Don't be dissuaded from reading this article because you have previously heard or read about how terrible health care is in Canada. Preserve enough of an open mind to hear about the situation from a physician who lives and works there. I am neither a defender of Canadian policy nor fearful that they may have found something better. I simply believe that we should take a straight look at data when it is presented. Before the 1960s, health financing in the US and Canada was virtually identical. Since then, we have had widely different experiences. Let's try to learn something from this health policy experiment.
Here are some excerpts:
On costs, Canada spends 10% of its economy on healthcare; the U.S. spends
16%. The extra 6% of GDP amounts to more than $800 billion per year. The
spending gap between the two nations is almost entirely because of higher
overhead. Canadians don't need thousands of actuaries to set premiums or
thousands of lawyers to deny care.
Because most of the difference in spending is for non-patient care,
Canadians actually get more of most services. We see the doctor more often and
take more drugs. We even have more lung transplant surgery. We do get less heart
surgery, but not so much less that we are any more likely to die of heart
attacks. And we now live nearly three years longer, and our infant mortality is
Canadians needing urgent care get immediate treatment. But we do wait too
long for much elective care, including appointments with family doctors and
specialists and selected surgical procedures. We also do a poor job managing
chronic disease. However, according to the New York-based Commonwealth Fund,
both the American and the Canadian systems fare badly in these areas. In fact,
an April U.S. Government Accountability Office report noted that U.S. emergency
room wait times have increased, and patients who should be seen immediately are
now waiting an average of 28 minutes. The GAO has also raised concerns about
two- to four-month waiting times for mammograms.
American democracy runs on money. Pharmaceutical and insurance companies
have the fuel. Analysts see hundreds of billions of premiums wasted on overhead
that could fund care for the uninsured. But industry executives and shareholders
see bonuses and dividends.
Take the time to read these thoughtful comments by Dr. Rachlis. We have nothing to fear from observing what our northern neighbors choose to do. We can, in fact must, improve how our health system functions. It is particularly important to note that our two countries spend vastly different proportions of the gross domestic product (GDP) on health care, with the US having the less favorable experience. Because we spend a greater portion of GDP on health care, we spend less on education, training, and product development, with consequential depletions of future GDP. Health care costs are threatening our economy, our tax base, and our way of life. Somehow we in the US are going to have to figure out how to stop giving away so much of our GDP to wasteful health industry practices.
Dr. Joe Jarvis