QandO: "Free" Health Care

July 13, 2004

"Free" Health Care
Posted by Dale Franks

Dr. Robert Cihak writes that Canada's health care system is working just fine. Unless you get, you know, sick, or anything.

Among those countries, Canada spends most on its system while ranking among the lowest in such indicators as access to physicians, quality of medical equipment and key health outcomes.

One of the major reasons for this discrepancy is that, unlike other countries in the study that outperformed Canada — such as Sweden, Japan, Australia and France — Canada outlaws most private health care. If the government says it provides a medical service, it's illegal for a Canadian citizen to pay for and get the service privately.

At the same time, to try to keep spending down, the government chips away at the number and variety of covered services. According to another Fraser Institute survey, this means that on average a patient must wait in line 17.7 weeks for hospital treatment.

In 1999, Dr. Richard F. Davies described how delays affected Ontario heart patients scheduled for coronary artery bypass graft (CABG) surgery. In a single year, just for this one operation, 71 Ontario patients died before surgery, "121 were removed from the list permanently because they had become medically unfit for surgery" and 44 left the province to have their CABG surgery elsewhere, often in the U.S.

In other words, 192 people either died or were too sick to have surgery before they worked their way to the front of the waiting line. Yet, the Ontario population of about 12 million is only 4 percent of the population of the United States.

In an article in the journal Health Affairs, Robert Blendon describes an international survey of hospital administrators in Australia, New Zealand, Great Britain, the U.S. and Canada. When asked for the average waiting time for biopsy of a possible breast cancer in a 50-year-old woman, 21 percent of administrators of Canadian hospitals said more than three weeks; only 1 percent of American hospital administrators gave the same answer.

Fifty percent of the Canadian hospital administrators said the average waiting time for a 65-year-old man who requires a routine hip replacement was more than six months; in contrast, not one American hospital administrator reported waiting periods that long. Eighty-six percent of American hospital administrators said the average waiting time was shorter than three weeks; only 3 percent of Canadian hospital administrators said their patients have this brief a wait.

Canadian physicians' frustration with their inability to provide quality and timely care is resulting in a brain drain. A doctor shortage looms as the nation falls 500 doctors a year short of the 2,500 new physicians it needs, according to Sally C. Pipes, president of the San Francisco-based Pacific Research Institute.

On average, a patient in Canada must wait 17.7 weeks before receiving hospital treatment. In 1999, that meant that, in a single year, 192 patients who needed heart bypass operations either dies, or became too sick to have the surgery--which, of course, means they died in due course as well--by the time their spot on the waiting list rolled around.

And this lenghty waiting is standard in Canada. 21% of hospital administrators in Canada said that the waiting time for breast cancer biopsies was more than three weeks. That compares to 1% of US administrators. Hip replacement surgery for the elderly? 50% of Canadian administrators say the wait averages 6 months. In the US, 86% say the wait is less than 3 weeks.

And that's the system that the Left wants to try and replicate in the US?

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Comments

The only thing about those US comparative wait-time stats is that they assume that the person with the condition can *afford* to go into the hospital for the bypass, biopsy, hip replacement, etc. I don't think that balances things back sufficiently toward the Canadian direction (though I don't know that for certain), but it's also something to consider in the equation: does treatment get delayed or prevented due to insufficient public funding of the medical system, or insufficient personal funding to pay for the individuals treatment?

Fully public-paid, free, universal health care is a pipe dream, simply because what consititutes necessary, and timely, and effective care is always going to be a compromise with the payers (the taxpayers, in Canada's case) and the individuals seeking what the treatment they want. That doesn't mean that the US system -- a blend between subsidized care for some poor and private employer/employee-negotiated insurance for most others -- is ideal, or couldn't bear some improvement.

Posted by: ***Dave at July 13, 2004 12:32 PM

A personal anecdote. As impoverished grad students, marginally covered by student insurance and not eligible for any govt money, my wife needed medical care that cost more than both of us made in a year *over and above* what was paid for by the insurance. There was *no* absolutely *no* difficulty in getting her admitted, treated, and cared for expeditiously, in what was essentially a non-emergency but serious situation. Only after all the service was provided was I invited in to discuss a payment plan. It took several years, but we got it paid. I suspect that if I had tried hard we could have stiffed them and gotten away with it.

I now also teach graduate courses in Health Policy. As near as I can tell, the only reason you would be unable to get similar treatment is that you simply don't understand how to make the system work, and it isn't that hard. Paying. That can be hard (for somebody). If we had not paid, aside from my feelings of personal integrity, we would have been jacking up everyone else's bill.

In Canada, we would have been SOL until she worked up the list, quite possibly with permanent damage.

Posted by: JorgXMcKie at July 13, 2004 03:39 PM

Basically in the US poor people can not afford a medical service and not get it.

In Canada the poor can afford a medical service because someone else is paying for it, but they still cannot get it.

The difference is soon in Canada, no one else will get it either.

Posted by: Frank Castle at July 13, 2004 05:43 PM

'Basically in the US poor people can not afford a medical service and not get it.'

sure they can...
isnt that what their 'Access' card is for?

Posted by: great satan at July 13, 2004 06:40 PM

mr. Castle,
the rest of your post is absolutely on the money...
gs

Posted by: great satan at July 13, 2004 06:42 PM

When we DO have a health care system in this country instead of a for-profit bureaucratic pastiche infested with 6-figure CEOs, and having almost 40 million people uninsured, maybe we will have something to compare with Canada's.

I found it interesting that Robert J. Cihak, the author of the above opinion, is a senior fellow and board member of the Discovery Institute.

"The Institute discovers and promotes ideas in the common sense tradition of representative government, the free market and individual liberty."

A couple of studies he mentions come from the Fraser Institute:

"Founded in 1974 at a time when many Canadians believed that government should be the principal source of growth and development in the economy, the Institute has helped bring about a considerable shift in public opinion in recognition of the importance of market competition."

Of course, there is nothing wrong with these organizations, but they are in opposition to non-profit government run entities. I just want a second opinion on the state of Canada's health care system.

Oh, by the way,
The Discovery Institute, in their Center for Science and Culture division (among other things):

"support research by scientists and other scholars challenging various aspects of neo-Darwinian theory"
"support research by scientists and other scholars developing the scientific theory known as intelligent design"

("Intelligent Design" elevated to theory? — yikes!)

Posted by: David Steele at July 14, 2004 05:52 AM

I grew up on welfare. My mother is now over 65 so she has Medicare but she has never had health insurance in her life. She nor I were ever turned away for medical treatment for any reason. It doesnt happen.

Thankfully now I have health care insurance so no more long waits in the hospital but the poor are not denied medical care.

Posted by: retired military at July 14, 2004 09:55 AM