A Brief Note on the Canadian Election
This is a screenshot of an ad run by the New Democratic Party (NDP) in the Canadian federal election held last Monday, October 19. Although the single-payer Canadian system is run by the provincial governments, the question of funding it dominates federal elections.
The NDP made a promise to increase federal grants to the provinces to pay for more doctors. So, the NDP decided to attack the Conservatives for a shortage of doctors.
To put this in perspective, the U.S. population is about ten times greater than Canada’s. So, the equivalent ad here would state “50,000,000 Americans with no family doctor,” or about one in seven. The NDP suggests this is a recent problem created by Conservative under funding. However, I wrote about this figure way back in 2009. It is a fundamental feature of government monopoly, single-payer, health care.
Family doctors are presumably the easiest to see. If 5 million people cannot see a family doctor, the prospect of seeing a specialist must really be daunting.
Every Canadian province has a web site that provides stats on wait times for various services. I randomly picked pediatric tonsillectomies and adult hip replacements in Nova Scotia.
Surgery wait times to have your kid’s tonsils removed:
Consult: 90% of people served within 161 days
Surgery: 90% of people served within 144 days
Total wait time = (wait time for consult) + (wait time for surgery).
Here are the wait times for Granny’s hip replacement:
Consult: 90% of people served within 228 days
Surgery: 90% of people served within 663 days
*10 months to get 90% of tonsillectomies done
*6 years to get 90% of hip replacements done
Surgical wait time starts running when there is an actual decision to operate, so this is the shortest total time, assuming the decision is made at the time of consultation. If the decision is delayed the wait time is longer. The data exclude days when the patient is unavailable or emergency cases.
A met a woman from Australia on a recent vacation. She told us that a couple of years prior, she learned that she needed to have her gallbladder removed and to expect that it could be done in about three weeks. Nine months later, she got a call to be at the hospital the next morning for the surgery. By then, complications had developed. Single payer healthcare doesn’t seem so great if you need actual care especially if it’s not immediately life threatening. We can have our healthcare good, fast or cheap. Pick any two.
The official provincial waiting lists are only a few years old. The provincial health ministries used to deny there were any waits. So, the Fraser Institute, a private non-profit think tank (like NCPA, and my former employer too) started surveying doctors and published the data in 1990 and every year since. The Fraser Institute’s efforts forced the provincial health ministries to become a little more transparent.
Canada, as I suppose you know, is ranked #30 in the world by the WHO, 7 ahead of the US (#37). France is #1. France has 50% more physicians than the US. It seems most useful to me to compare our insane system with the best, instead of a much less successful single-payer system. I imagine that many Canadian physicians opt to move to the US hoping to get rich thus creating a shortage in Canada. Maybe English-speaking countries have a problem organizing a system that won’t either bankrupt tens of thousands of the people who have to use it or create long waiting lists. I have numerous friends in Vancouver and have yet to hear that people in Canada are actually suffering from the lack of health care. We’re the only developed country with health care-caused bankruptcies.The cost of almost all medical services in the US, after whatever insurance one might have, is so far beyond the ability of most Americans to reasonably pay, and is so arbitrary, unpredictable and opaque that it’s hard to imagine how much longer we’ll put up with it. This cost is a huge tax on every product and service in this country. At 67 my road bike is my health care- 20 mi/day commuting with the occasional sprint to make a light or charge a short grade. My need for healthcare is essentially nil. I have medicare with no supplement because there’s no money to pay for it.
France is #1 using whatever criteria WHO decides to use. French GDP is also 53% public spending.
Here is an article about “free” health care in France by someone who doesn’t understand economics, or at least the concept of TANSTAAFL. http://www.slate.com/articles/business/dispatches_from_the_welfare_state/2014/01/french_socialized_medicine_vs_u_s_health_care_having_a_baby_in_paris_is.html
Now riddle me this: the woman gushes about this #1 health care system where you have reserve a maternity bed as soon as you miss your period and where you have to bring your own towels to the hospital.
From the same article: “Women who are likely to have complication-free births are usually referred to a Level 1 maternity ward, which has an operating room in case a C-section is necessary but no neo-natal unit or full hospital facility attached to the clinic. In the U.S., most women deliver at a full-service hospital, even if it’s likely they will experience no complications.”
This reflects a serious lack of understanding of statistics. Statistics apply to groups, not individuals. Statistically a young healthy nonsmokers is low risk for cancer but that didn’t keep comedian Andy Kaufman from suffering the same fate as old smoker John Wayne.
Chances are the mother and baby will be fine, but if it’s not fine then the SHTF. You see the same thing here in the US with home births done by midwives. Its all good until it isn’t and then it can go bad fast. It’s not common but when it’s you or your child who is injured or killed the incidence is 100%. So France is basically saying it costs too much to protect against a few maternal or infant deaths.
Leonard Schaeffer and other health experts tell us that the health status of a population is attributable to the following four factors: (1) personal behavior including diet, exercise, smoking, drinking, weight, etc. (40%); genetics (30%); socioeconomic status and environmental factors (20%); and the quality of healthcare that one has access to (10%).
While both life expectancy and infant mortality lend themselves nicely to precise measurement and quantification, they tell us very little about the quality of healthcare in any given country. Poverty is an especially important issue for both infant mortality and life expectancy. There are even differences among countries in the definition of a live birth with the U.S. using the broadest definition.
We also have a higher rate of obesity in the U.S. and we have more people who die per 100,000 of population from gun violence, suicide, drug overdoses and car and motorcycle accidents than other countries. Even the best rescue care in the world, which we have, can’t prevent most of those premature deaths.
The bottom line is that the WHO rankings of healthcare quality are basically worthless in my opinion. If I needed sophisticated care for a life threatening condition, I would rather be in the U.S. than anywhere else when I needed it.
I question the data simply because I don’t trust how it’s gathered. If you tell me Denmark has lower maternal mortality rates I can entertain that possibility, but what’s hard to believe are the superlative data from Estonia, Macedonia, Hungary, Iran, Puerto Rico, Bosnia, Belarus, etc, that all rank above the USA.
Here’s how bad data collection can be even in a country obsessed with statistics. In mid-2015 there were a lot of breathless headlines about how maternal mortality had doubled in the US in the first 15 years or so of the 21st century.
In 2003 death certificates were changed to include whether or not the decedent was pregnant. Suddenly we had a “crisis” in maternal deaths.
Can we even compare deaths among various states? Well, some states still haven’t adopted the “new” death certificate. So even within a data-obsessed country it’s not homogeneous.
How long do you track maternal deaths? CDC tracks from pregnancy to 42 weeks post-partum. Other researchers track for a year. How good are people at filling in cause of death? How many new mothers die in auto accidents in a year?
When comparing national infant mortality you have to determine whether that country considers it a live birth if the baby is born alive (as in the US) or only if it survives the first 24 hours like certain other countries. A 5 month premie is a live birth in the US and we can often keep them alive but chances are it won’t survive 24 hours in most countries. Although it won’t be exposed in the wilderness like Oedipus it will be allowed to die in the nursery.
You’ve also touched on whether the health care system can be held accountable for patient behavior. This is what’s wrong with the concept of “pay for performance”. A doctor can’t live at your house and make sure you take your insulin and avoid sugar, yet P4P would have doctors’ pay tied to how many diabetics under their care have good blood sugar control.
“Medical bankruptcy” (a suspect term) is the same or slightly higher in Canada than the U.S. See Brett Skinner,”Health Insurance and Bankruptcy Rates in Canada and the United States,” Fraser Institute, 2009.