Has Canada Got the Cure?

By Holly Dressel, YES! Magazine. Posted August 29, 2006.

Should the United States implement a more inclusive, publicly funded health care system? That's a big debate throughout the country. But even as it rages, most Americans are unaware that the United States is the only country in the developed world that doesn't already have a fundamentally public--that is, tax-supported--health care system.

That means that the United States has been the unwitting control subject in a 30-year, worldwide experiment comparing the merits of private versus public health care funding. For the people living in the United States, the results of this experiment with privately funded health care have been grim. The United States now has the most expensive health care system on earth and, despite remarkable technology, the general health of the U.S. population is lower than in most industrialized countries. Worse, Americans' mortality rates--both general and infant--are shockingly high.

Different paths

Beginning in the 1930s, both the Americans and the Canadians tried to alleviate health care gaps by increasing use of employment-based insurance plans. Both countries encouraged nonprofit private insurance plans like Blue Cross, as well as for-profit insurance plans. The difference between the United States and Canada is that Americans are still doing this, ignoring decades of international statistics that show that this type of funding inevitably leads to poorer public health.

Meanwhile, according to author Terry Boychuk, the rest of the industrialized world, including many developing countries like Mexico, Korea, and India, viscerally understood that private insurance would [never be able to] cover all necessary hospital procedures and services; and that even minimal protection [is] beyond the reach of the poor, the working poor, and those with the most serious health problems. Today, over half the family bankruptcies filed every year in the United States are directly related to medical expenses, and a recent study shows that 75 percent of those are filed by people with health insurance.

The United States spends far more per capita on health care than any comparable country. In fact, the gap is so enormous that a recent University of California, San Francisco, study estimates that the United States would save over $161 billion every year in paperwork alone if it switched to a singlepayer system like Canada's. These billions of dollars are not abstract amounts deducted from government budgets; they come directly out of the pockets of people who are sick.

The year 2000 marked the beginning of a crucial period, when international trade rules, economic theory, and political action had begun to fully reflect the belief in the superiority of private, as opposed to public, management, especially in the United States. By that year the U.S. health care system had undergone what has been called "the health management organization revolution." U.S. government figures show that medical care costs have spiked since 2000, with total spending on prescriptions nearly doubling.

Cutting costs, cutting care

There are two criteria used to judge a country's health care system: the overall success of creating and sustaining health in the population, and the ability to control costs while doing so. One recent study published in the Canadian Medical Association Journal compares mortality rates in private forprofit and nonprofit hospitals in the United States. Research on 38 million adult patients in 26,000 U.S. hospitals revealed that death rates in for-profit hospitals are signifi cantly higher than in nonprofit hospitals: for-profit patients have a 2 percent higher chance of dying in the hospital or within 30 days of discharge. The increased death rates were clearly linked to "the corners that for-profit hospitals must cut in order to achieve a profit margin for investors, as well as to pay high salaries for administrators."

Holly Dressel is the co-author of Good News for a Change. This article was adapted from her forthcoming book, "God Save the Queen--God Save Us All: An Examination of Canadian Hospital Care via the Life and Death of Montreal's Queen Elizabeth Hospital" (McGill/Queen's Press, 2007).

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