Donald Trump has committed far more egregious outrages than attacking the Canadian health care system.
In case you missed it in the welter of ugly and vicious slurs, during last Sunday’s presidential debate the New York billionaire-who-is-proud-of-paying-no-income-tax accused Hillary Clinton of wanting to institute a Canadian-style, single payer health care system.
The Canadian system, the real estate developer claimed, engenders long wait times and causes a great many Canadians to seek treatment in the United States.
The accusation against Clinton is entirely false. It is Bernie Sanders who advocates something resembling the Canadian system, not Ms. Clinton, who argued vigorously during the primaries that Sanders’ idea was, in essence, pie-in-the sky.
As for Trump's claim that Canadians are streaming across the border to seek medical treatment -- at best, it is vastly exaggerated.
But those are among the least offensive statements the Republican nominee has made in a long time.
No wonder the U.S. news media do not think them newsworthy.
They have bigger -- and far more malodorous -- fish to fry.
Canadians should, however, be concerned when U.S. politicians tell lies about our health system. There is a lot wrong with Canadian health care, including unconscionably long wait times for some procedures. But it is up to Canadians to fix what does not work, and we should not allow our understanding of our own system to be clouded by false myths spread south of the border.
OECD reports shine light on countries' performance
Wait times are a legitimate concern, and Americans who do not like so-called socialized or government-controlled health care often seize upon that issue when excoriating the Canadian system.
But there is more to health care -- and health, more broadly speaking -- than the time one must wait for certain surgeries or treatments.
The Paris-based Organisation for Economic Coöperation and Development (OECD) is no hot bed of socialist thinking. In fact, for the most part, it is an unabashed advocate of capitalist economics, or, to use the current catch phrase, market-based solutions.
The OECD does, however, respect data and facts, and on health care it has amassed a treasure trove of both.
If you look at the OECD's recent publication Health Care at a Glance 2015 you will find concise analyses of how well the health-care systems of a number of wealthy and middle-income countries perform.
In its analysis of the U.S. system, the OECD says that life expectancy in the U.S. is lower than in most other OECD countries because of "poorer health-related behaviours and the highly fragmented nature of the U.S. health system."
The OECD points to the salutary fact that the proportion of adults in the U.S. who smoke is among the lowest in OECD countries. But it then adds the much less salutary fact that alcohol consumption in the U.S. is rising and, worse, the U.S. obesity rate is the highest of all OECD countries -- by far.
As for the delivery of services in the United States’ private enterprise dominated system, well, the OECD says that in the U.S., the quality of acute care in hospitals is, in fact, "excellent." However -- and here’s the rub -- the U.S. health system performs poorly in providing appropriate treatment and service for people with chronic diseases.
What that means is that if you are an American who suffers a life-threatening condition such as a heart attack you will be effectively treated in a hospital.
If, however, like millions of Americans you have a chronic health condition, such as asthma or diabetes, you will not get much in the way of management or treatment until your symptoms become so severe you have to be admitted to a hospital.
U.S. spends more than twice the OECD average on health care
What the U.S. desperately lacks, the OECD says, is well-organized primary (as opposed to acute) health care and good public health services. The result is that chronic disease patients end up in acute care hospitals, because there is no other, more appropriate, care for them.
And so the U.S. system is good at the heroic stuff, but does a below average, even poor job overall of keeping people healthy.
As well, in the U.S. services are very unevenly distributed, with the poor getting significantly shorter shrift than the rich.
That is why Americans can expect to die younger than the citizens of the majority of OECD countries, including Canada.
Life expectancy in the U.S. hovers around 78 years. In the majority of OECD countries it is over 80 years. In Canada it is over 81 years.
And here is the truly shocking part, or what should be, for Americans.
The US spends more -- way more -- than any other OECD country on health care. In fact, it spends two and a half times the OECD average.
The United States spends more than 16 per cent of its gross domestic product (GDP) on health. The average for the OECD is 8.9 per cent. Canada’s spending is a bit above average, at slightly more than 10 per cent of GDP.
As for Canada’s performance, on the whole, in its 2015 evaluation of Canada’s health care system, the OECD reports that while Canada’s life expectancy is higher than the OECD average, and three years higher than that of the United States, it is still quite a bit lower than the life expectancy of the leading OECD countries: Spain, Switzerland and Japan.
In addition, although the obesity rate in Canada is lower than in the U.S., it is still higher than the OECD average.
Canada does better than U.S., but has much room for improvement
The OECD gives Canada good marks for the treatment of cancers, but adds that Canada could do better in reducing cancer incidence, through prevention strategies and by promoting early diagnosis and better treatments.
And then there is the question of the availability of primary care and the effectiveness of public health measures, as indicated by the degree to which Canada uses acute care hospitals to treat chronic conditions such as diabetes. On this key OECD indicator, Canada is doing better than it has, and quite a bit better than its neighbour to the south, but, the OECD says, it could still improve.
That's the big picture.
Nobody's perfect. All countries have room for improvement.
But the U.S. has quite a bit further to go than the majority of OECD countries, including this country, as imperfect as it is.
The bottom line is that single-payer Canada -- with its government-dominated, (supposedly) costly and inefficient system -- spends much less on health care than does free enterprise U.S., while it achieves, overall, much better results.
What are the chances these facts will ever emerge in the current U.S. election campaign?
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