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Countering U.S. attacks on Canadian health care

St. Paul's Hospital in Vancouver. Photo: Can Pac Swire/Flickr

A friend travelling in Europe pleaded recently on Facebook for information to help her respond to a fellow tourist, an "alpha male" from the U.S., who was criticizing the Canadian health-care system. He claimed, for example, that he had seen statistics showing that 20 per cent of Canadians go to the U.S. each year for elective surgery.

We should brace for more such criticisms, as Senator Bernie Sanders and at least some Democrats promote what they call "Medicare-for-All" as a plank for the 2020 US elections. They view Canada's system as a possible model. As for my friend, I did some quick research and responded to her, as did a number of her other Facebook contacts.

Ignorantly wrong

The alpha male critic is simply and ignorantly wrong to say that 20 per cent of Canadians (seven million people) go to the U.S. annually for elective surgery. The Vancouver-based Fraser Institute is a right-wing organization known for its hostility to Medicare. It claims that 63,000 Canadians sought medical treatment in other countries in 2016. The Fraser Institute frequently writes ideological reports whose methodology is suspect, and several academics have said that this report is not accurate either. But even if it were, there is a big difference between 63,000 Canadians going to a variety of countries for health care, and seven million going to the U.S. alone every year.

Interestingly, a publication called the Fiscal Times estimated in 2016 that 1.4 million Americans would leave the country in that year for medical procedures. That is mainly because health care in the U.S. is so expensive. In fact, some employers actually encourage their insured workers to seek cheaper care elsewhere.

Yes, in some cases waiting lists in Canada are too long, particularly on elective surgeries for less serious conditions. But I can say that when I was diagnosed with a blood clot in my lower leg late in 2018, I saw my family doctor on a Wednesday, had an ultra-sound on Friday, and visited a specialist on Saturday. I was impressed. Also, our daughter recently had a baby and the medical and associated care was excellent.

Cost comparisons

I am not an expert on health costs, but a quick bit of research provides some interesting comparisons. A study by the Kaiser Family Foundation found that in 2017 the US spent 17 per cent of its GDP on health care. Canada spent 10.5 per cent, and the average in comparable countries (Canada, Germany, U.K., France, Belgium, Austria, Australia and Switzerland) was 10.6 per cent. In dollar terms in 2017, the U.S. spent $10,224 per capita on health care. Canada spent $4,826, and the average among comparable economies was $5,280.

Contrary to common belief, there are publicly-funded health-care programs in the U.S. as well, for senior citizens, military veterans and others. Yet most people there have either to pay for services out of pocket, or to face hefty insurance premiums. The Kaiser study also found that spending in the U.S. public health-care sector is quite similar to that in other countries. It is the private sector that is so costly. There are numerous possible answers as to why, but surely high profits extracted from the system and the cost of advertising to compete for clients would be a big part of the reason.

Millions uninsured

And while under Medicare everyone in Canada has access to hospital care, doctors' visits and associated laboratory and diagnostic services, the same cannot be said in the U.S. The government's own National Center for Health Statistics reported that in September 2016, 12.3 per cent of Americans adults aged 18–64 were uninsured.

That was a big improvement over earlier years when more than 20 per cent of those same people lacked insurance. The Affordable Care Act (commonly called Obamacare) is the most obvious reason why more people came to be covered. But the Republicans are doing their best to reverse Obamacare so the number of uninsured may well rise again.

Life expectancy

I am not expert in health outcomes either but one statistic caught my attention. In 2015, the world's highest life expectancy at birth was 83.7 years in Japan. Canada ranked 12th at 82.2 years and followed countries such as Switzerland, Singapore, Australia, Spain, Iceland, Italy, Israel, Sweden, France and South Korea. The U.S. ranked 31st in the world with a life expectancy of 79.3 years, just after Chile and Costa Rica, and just ahead of Cuba, at 79.1 years.

Surely life expectancy is an important health outcome. If so, one has to ask why the U.S., which spends much more on health care than any comparable country, ranks 31st in the life expectancy of its residents.

From what I've seen on Facebook, my friend continues to enjoy her European vacation. I will be curious to know how her fellow tourist responded when provided with the facts.

Dennis Gruending is an Ottawa-based writer and a former MP. This piece appeared on his Pulpit and Politics blog on March 24, 2019. 

Photo: Can Pac Swire/Flickr

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