Intermission: How Do You Measure Health Care?

Before I continue addressing the President’s speech, let me address a couple comments I received from a friend in Canada regarding the previous post. Bear with me while I respond to his question and divulge a few personal accounts. I will continue with the speech in tomorrow’s post.

My friend states,

You said Obama “claimed that the United States is the only democracy, the only wealthy nation that allows health related hardship for millions of it’s people, while the people of many other democracies and wealthy nations are suffering far more than we are.”

Well, we’re not. Compare Canadian life expectancy, infant mortality, cost of health care per person, and universality of access to yours.

and in a follow up comment he adds,

Based on the most recent stats available from the WHO, here’s how the “far better” US system stacks up to the Canadian system.

Life Expectancy: 81 years in Canada, 78 years in the US.

Population with access to treated drinking water: 100% in Canada, 99% in the US.

Deaths/1000 among children under 5: 6 in Canada, 8 in the US.

Adult Mortality rate (probability of dying between 15 to 60 years per 1000 population): 72 per thousand in Canada, 109 per thousand in the US.

Total expenditure on health as percentage of gross domestic product: 10% in Canada, 15.3% in the US.

Per Capita expenditures on Health in US$: $3912 in Canada, $6714 in Canada.

Hospital beds per 10,000 population: 34 in Canada, 32 in the US.

So…by what measure do you figure your system is better than ours? Just curious.

Those statistics from the World Health Organization sure look good. Life expectancy, infant mortality, cost of health care per person, and universality of access all appear to be much better than ours here in the United States, but let’s look at the whole picture, not just general statistics, or one political view.

I am sure the WHO statistics are true, I am not going to try and disprove them, as that would be ridiculous. But let’s keep in mind that there is a whole lot more to health care than general statistics and overall numbers. What looks good on paper can be very deceiving, and misleading.

Does it matter if Canadians live three years longer than Americans if their quality of health care (and quality of life) are not any better than ours here in America? I would certainly give up three years of my life if it meant having a higher quality of life in the years that I did have remaining.

Believe it or not I have a lot of experience with the Canadian health care system. My mother is a naturalized American who came to the United States from Canada when she was two years old. Her sister, mother, father, uncle, aunts, grandmothers and grandfathers were all born in Canada. I have seen what the Canadian health care system has done to my relatives.

In 1982 I was living in Hawaii with my grandmother while attending college. I met my great-uncle Bob and his wife Isabel for the first time. My uncle Bob and I bonded immediately. He understood the angst of a 17 year old kid living in a strange place (I had never lived outside my small home town before I left for college). He spent time telling me all about his life and I shared my life with him.

One day, while we were walking outside he started rubbing the side of his face. He seemed to be applying a lot of pressure and looked uncomfortable. I asked him if something was wrong and he told me how his face, just one side, would tingle and go numb for several minutes at a time. I asked him what his doctor said, to which he replied, “I’ve only been able to see one doctor and that was months ago”. His doctor thought it might be some sort of “nerve disorder” but they could not be sure until they ran some tests and those tests were not scheduled until they returned to Canada. It was the earliest he could be seen at the time.

He experienced those episodes several times during his vacation, and insisted his doctor would “take care of it” when he got home. When he and Isabel boarded the plane to return to Canada, it was the last time I would see him in person. We exchanged letters for several months, and I spoke to him on the phone a few times.

The last time I heard from him, he had still not seen a doctor. His “elective” appointment for “facial tingles” was delayed. Time and time again. Then, in December of 1983, he died. He suffered a massive heart attack, was rushed to the hospital, and it was discovered that the “nerve disorder” was simply a symptom of a much more serious heart problem.

This wasn’t an issue of a misdiagnosis, this wasn’t an issue of poor judgement in the prescription of medication. This was a result of the lack of proper health care. Whatever the reason, whether it was an effort to save money (rationing) or just a coincidence that he died from the very thing he was seeking medical treatment for, we’ll never know, will we? I don’t have statistics from the WHO or any other organization on the number of untreated cases, the quality of care, or the long term prognosis for people like my uncle Bob. He was my uncle, not a statistic.

Many years later, while living back in Las Vegas, my aunt Isabel came to visit. While she was visiting, she felt weak and wanted to go to the hospital. It was quickly determined that she had suffered from a stroke, and received health care at one of Las Vegas’ premiere hospitals. When she was discharged, many weeks later, her American doctor advised her what needed to be done for follow up care, and she went home to Canada.

Aunt Isabel is still living in British Columbia, but her quality of life has not been good for a very long time. Shortly after returning to Canada she suffered another stroke. Over the years she suffered even more “mini strokes”, and just a couple years ago, she suffered another big one. I don’t talk to her, or my cousin, as much as I should, but I know she hasn’t been to see a doctor nearly as much as she should have.

The question is, would she have suffered so many strokes if she lived here in the United States? Who knows. We have no way of knowing that, but there is one thing I do know. She would have seen her doctor a heck of a lot more living here than she has in Canada. Do I have statistics to back this up? Nope. All I have is her personal account of what she’s endured under the Canadian health care system.

Because I know my friend, I know these personal accounts will mean nothing in the overall argument about health care (as far as he’s concerned), so now I will point out a few facts and statistics, from other sources, which may clarify why I figure that our system is better than that in Canada.

According to the National Center For Policy Analysis,

  • Americans have lower cancer mortality rates than Canadians.
    • Breast cancer mortality is 9 percent higher, prostate cancer is 184 percent higher and colon cancer mortality among men is about 10 percent higher than in the United States.
  • Americans have better access to preventive cancer screening than Canadians.
    • Take the proportion of the appropriate-age population groups who have received recommended tests for breast, cervical, prostate and colon cancer:
      • Nine of 10 middle-aged American women (89 percent) have had a mammogram, compared to less than three-fourths of Canadians (72 percent).
      • Nearly all American women (96 percent) have had a pap smear, compared to less than 90 percent of Canadians.
      • More than half of American men (54 percent) have had a PSA test, compared to less than 1 in 6 Canadians (16 percent).
      • Nearly one-third of Americans (30 percent) have had a colonoscopy, compared with less than 1 in 20 Canadians (5 percent).
  • Lower income Americans are in better health than comparable Canadians.
    • Twice as many American seniors with below-median incomes self-report “excellent” health compared to Canadian seniors (11.7 percent versus 5.8 percent). Conversely, white Canadian young adults with below-median incomes are 20 percent more likely than lower income Americans to describe their health as “fair or poor.”
  • Americans spend less time waiting for care than patients in Canada and the U.K.
    • Canadian and British patients wait about twice as long – sometimes more than a year – to see a specialist, to have elective surgery like hip replacements or to get radiation treatment for cancer. All told, 827,429 people are waiting for some type of procedure in Canada. In England, nearly 1.8 million people are waiting for a hospital admission or outpatient treatment.
  • People in countries with more government control of health care are highly dissatisfied and believe reform is needed.
    • More than 70 percent of German, Canadian, Australian, New Zealand and British adults say their health system needs either “fundamental change” or “complete rebuilding.”
  • Americans are more satisfied with the care they receive than Canadians.
    • When asked about their own health care instead of the “health care system,” more than half of Americans (51.3 percent) are very satisfied with their health care services, compared to only 41.5 percent of Canadians; a lower proportion of Americans are dissatisfied (6.8 percent) than Canadians (8.5 percent).
  • Americans have much better access to important new technologies like medical imaging than patients in Canada or the U.K.
    • Maligned as a waste by economists and policymakers naïve to actual medical practice, an overwhelming majority of leading American physicians identified computerized tomography (CT) and magnetic resonance imaging (MRI) as the most important medical innovations for improving patient care during the previous decade. The United States has 34 CT scanners per million Americans, compared to 12 in Canada and eight in Britain. The United States has nearly 27 MRI machines per million compared to about 6 per million in Canada and Britain.
  • Americans are responsible for the vast majority of all health care innovations.
    • The top five U.S. hospitals conduct more clinical trials than all the hospitals in any other single developed country. Since the mid-1970s, the Nobel Prize in medicine or physiology has gone to American residents more often than recipients from all other countries combined. In only five of the past 34 years did a scientist living in America not win or share in the prize. Most important recent medical innovations were developed in the United States.

All of these statistics, or facts, come from sources such as the National Program of Cancer Registries, the U.S. Centers for Disease Control; the Canadian Cancer Society/National Cancer Institute of Canada, the Fraser Institute, the England Department of Health, the Organization for Economic Cooperation and Development, the U.S. Department of Health and Human Services, the Nobel Prize Internet Archive, and various media reports.

These are not conservative “talking points”. These are simply additional statistics to consider with the numbers presented from the World Health Organization. If we’re going to look at whose health care system is better, we should look at the entire picture, not just pieces we choose to put under the magnifying glass.

With that in mind, make sure you read The Top Ten Things People Believe About Canadian Health Care, But Shouldn’t from The Heritage Foundation.

A 2005 survey by the College of Family Physicians of Canada, the Canadian Medical Association, and the Royal College of Physicians and Surgeons of Canada reported that more than 4 million Canadians do not have access to a family doctor. 12% of the Canadian population did not have access to a family doctor in 2005.

When it comes to health insurance in America, President Obama has made the claim that 47 million Americans “cannot get coverage”. During his speech to the Joint Session of Congress that number changed to 30 million. The White House later released a statement that the 30 million number does not include illegal immigrants. Using that number, the number of Americans who “cannot get coverage” is 9.86%. (We know from the second post in this series that the true number is closer to 14 million or 4.6%).

That same Canadian survey also states that more than 3,800 doctors plan to retire in the next two years and that 60% of family physicians are already limiting or refusing new patients.

Oh, and Americans are not the only ones talking about reforming their system of health care.

In an article dated August 16, 2009, the incoming president of the Canadian Medical Association said the country’s health-care system is sick and doctors need to develop a plan to cure it.

Dr. Anne Doig says patients are getting less than optimal care and she adds that physicians from across the country – who will gather in Saskatoon on Sunday for their annual meeting – recognize that changes must be made.

“We all agree that the system is imploding, we all agree that things are more precarious than perhaps Canadians realize,” Doing said in an interview with The Canadian Press.

the article continues,

Doig says there are some “very good things” about Canada’s health-care system, but she points out that many people have stories about times when things didn’t go well for them or their family.

“(Canadians) have to understand that the system that we have right now – if it keeps on going without change – is not sustainable,” said Doig.

Canada’s own medical community knows that their existing system is not sustainable, so why should we, here in America, be so quick to rush into a single payer system that has proven to reduce the quality of health care and break the bank in country after country, after country?

When it comes to health care and treatment, there are horror stories from both sides of the border, but when you hear those stories you never hear of Americans seeking treatment in Canada for specialized procedures that are not available here.

In many discussions and debate about health care I keep hearing that I need to remove my “partisan blinders”. What part of wanting the best health care choices for Americans is being partisan? I don’t support the current health care bill introduced in the House. I don’t support anything similar to that bill. I agree whole-heartedly that we need health care reform in America, I just don’t think we need to totally overhaul the entire system to make sure that an additional 4.6% of the population has access to health care.

Even CNN, one of the most liberal news outlets in America, reports some of the horror stories from the Canadian health care system. I don’t need CNN, FOXNews, or any other media outlet to remind me of the horrors of the Canadian health care system.

Whether I consider “elective” surgeries like knee replacement surgery, life expectancy, cancer survival rates, mortality rates, or any other statistic touted in this post or anywhere else, I still feel that Americans have better quality health care.

Knee replacement surgery might be “elective” but waiting for that replacement can be very painful and no one should have to wait four months or more for that surgery. People suffering from “facial tingles” should not wait more than six months, and die, before they are seen to have tests administered. What good is a longer life expectancy if you are in pain or miserable while you are waiting for treatment?

I’d much rather choose the health care system that is capable of treating the “big stuff” like cancer if it comes along, rather than the one that puts me on a waiting list for “elective” surgeries that could ease my pain, limits access to radiation services to treat my cancer, and treats me as a number in the system while touting “universal coverage for all”.

So, in conclusion, I hope that answers the question, “by what measure do you figure your system is better than ours?” We can argue points back and forth until we are blue in the face and it won’t change the fact that both systems, American and Canadian alike, need serious work.

Now, if you pardon me, I have to get back to analyzing President Obama’s speech to the Joint Session of Congress.

One thought on “Intermission: How Do You Measure Health Care?

  1. Michael:

    A few weeks ago we exchanged comments about health care in Canada and the U.S. Your last comment to me, that you preferred having a good quality of life versus a longer life was interesting, and was a topic on which I had no information. Recently, the Conference Board of Canada ( released an interesting report on health outcomes in 17 countries based on 11 criteria.

    The section of the report on “Life Expectancy” gives an indicator called the “Health-adjusted life expectancy”(HALE) which is the average number of years a person can expect to live in good health using a calculation that weights the severity of the health problem. In 2003, the last year for which the HALE data are available, the report shows Canadians to be fourth last with good health for 90 per cent of their lives. Americans are last with an average of 89 per cent of their lives in good health. Japan is first.

    When it comes to self-reported health states, Canadians are first, Americans a close second, and the Japanese are last. (Perhaps this ranking can be explained in part by younger populations in Canada and the U.S. compared to an older population in Japan).

    Except for total cancer mortality, the study shows Canada outperforming the U.S. on each of the 11 criteria. However, Canada’s ranking for overall health within 16 of the countries was only 10th (the U.S. was last), with an infant mortality rate of 15th out of 17 countries (the U.S. was 17th).

    The headline in my local paper was “Our infant mortality rate among the worst:survey”. The report cvertainly suggests that Canada needs to shape up in this area.

    The director of health policy for the Conference Boarxd of Canada was quoted in the same newspaper article as stating that the quality of a country’s health-care system is responsible for about 25 per cent of the level of overall health indicators, and socio-economic factors such as housing,education and social support make up about 50 per cent. Other marginal factors account for the remaining 25 per cent.

    Now that’s an interesting claim.


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