Sunday, December 9, 2007

Up here; down there: the symbiotic Canada - U.S. health system and two-tier fear

Paul Howard, managing editor of, and a senior fellow at the Manhattan Institute’s Center for Medical Progress, wrote in “The Health of Nations”, (National Post, Dec.7, 2007):

“If you listen to left-leaning critics attack U.S. health care, some version of this complaint from New York Times columnist Paul Krugman invariably surfaces: “Americans spend more on health care per person than anyone else … Yet we have the highest infant mortality and close to the lowest life expectancy of any wealthy nation.”

But as Canadian physician David Gratzer has pointed out, health outcomes like infant mortality and life expectancy aren’t always a reflection of health care; instead, they represent a “mosaic of factors such as diet, lifestyle, drug use and cultural values.” For instance, in The Business of Health, economists Robert Ohsfeldt and John Schneider show that once you factor out U.S. accident and homicide rates (which are abnormally high in the United States), Americans actually live longer than their counterparts in other wealthy Western nations.

Gratzer’s argument got another big boost recently when economist and former Congressional Budget Office director June O’Neill and her husband, economist Dave M. O’Neill, released a study comparing U.S. and Canadian residents’ health status, health care and access to care.
The study makes for compelling reading. First, the authors point out that infant mortality and life expectancy are poor proxies for health-system performance. Take infant mortality, which averages about 6.8 deaths per 1,000 live births in the United States, compared with 5.3 in Canada. Advantage Canada?

Not so fast. Infant mortality strongly correlates with low birth weight and pre-term births, both of which are likelier among teen mothers. And the United States has nearly three times Canada’s rate of teen births, and about seven times Japan’s and Sweden’s. If you break down infant mortality rates in the United States even further, by race, you find that both “the pre-term infant mortality rate and the teen birth rate are considerably higher for blacks than for whites.” This means that America’s diverse ethnic mix plays against it in comparisons with more homogeneous countries. Once you factor in America’s high rate of low-weight births, an interesting statistic emerges: “If in Canada the distribution of births by birth-weight was the same as in the United States, their infant mortality rate would rise to 7.06.” Conversely, if the United States had Canada’s distribution of low-weight births, its infant mortality rate would drop to 5.4.

This means that access to health care probably isn’t to blame for America’s higher infant mortality. Education, diet, smoking, and other cultural factors are likely to play powerful roles in fetal health that aren’t captured in infant-mortality rates. And those rates affect life expectancy, making it another poor metric for measuring U.S. health-system performance.

Perhaps the most surprising findings in the O’Neills’ report come from their analysis of the Joint Canada/United States Survey of Health, which asked the same questions of U.S. and Canadian respondents. American patients had higher rates of chronic diseases, partly because of the high incidence of obesity in the U.S. — not a problem that you can lay at the feet of Big Insurance, by the way. But they also had greater access to treatments for those diseases. And American patients had much better access to cancer-screening programs — for instance, mammograms, Pap smears, colonoscopies, and PSA tests for prostate cancer. Unsurprisingly, though the incidence rates for breast, lung and colorectal cancer were higher in America than in Canada, the likelihood of dying from the disease was lower in the United States. (Cervical cancer was the sole exception to this trend.)

Fine, critics might say: Canadian patients don’t get as much high-tech care for cancer, but at least every Canadian, regardless of income, has equal access to health care, right? Wrong again. When it comes to this relationship, called the income/health gradient, the O’Neills found that, after taking into account America’s greater income variation, the United States actually did somewhat better than Canada among 18–64 year olds. Income typically acts as a proxy for education and other social advantages that make it easier for wealthier patients to navigate any health-care system. In Canada, where care is rationed, poorer patients have fewer connections and less ability to “jump the queue” to get needed care abroad or from private (and often questionably legal) clinics.

The most enduring lesson here is that broad metrics like infant mortality and life expectancy are heavily influenced by behavioral factors for which no health-care system can take the credit or blame. But if a serious disease like cancer is threatening your life, there’s still no place on earth you’d be better off than the United States.”

Michael (Sicko) Moore spouted some of the typical left-wing rhetoric Howard describes in his opening paragraph. In a Toronto Sun article (by Bruce Kirkland, May 20, 2007), Moore babbles “I’m an American saying something is wrong with our system, something is right in Canada”. [Mike, even Canadians, even Canadian Liberals, are saying there’s something wrong with the Canadian system. Even American liberals are not pointing to Canada as the template for U.S. reforms. There are charter challenges in Ontario courts right now in 2007 disputing the government’s right to deny supposedly-covered Ontarians timely health-care.]

Yet Moore claims that Government–run (as he said when shilling his Sicko fictiomentary on Leno) healthcare is somehow better than what Americans have now?! In the odd symbiotic relationship our two countries have now, Canadians are going to the supposedly-sicko United States for treatment, because, although we’re supposedly “covered” by universal medicare, universal medicare ISN’T ALWAYS AVAILABLE when patients need it. Is this the kind of Canadian failing health-care model Moore is shilling to be foisted onto Americans?

“If serious disease like cancer is threatening your life, there’s still no place on earth you’d be better off than the U.S.”, said Howard’s article above. The 2005 Chaoulli charter decision in Quebec (which successfully challenged the province's right to ban patients from buying private health insurance) was summed up by saying the court found that access to a waiting-list for universal health-care, is not actual access to health-care.

In other words, this is something a Hollywood dream-maker should understand: universal, single-payer healthcare, as practised in Canada for the last 40 years, is an illusion, a ‘state-of-promise’; it is ‘virtual healthcare’, but not necessarily real, accessible, available-when-necessary health-care. Moore claims: “You’re in a longer line than we are because you get to live three years longer than we do. Why is it that you [Canada], the French, the Brits, have a longer life expectancy. A baby born in Toronto has a better chance of living to its first birthday than a baby born in Detroit.” Maybe Moore should read and understand Howard’s article, before blowing his trumpet that socialized medicare is the sole political answer to all of life’s problems.

Universal healthcare is not the same as state-run monopoly medicare.

Moore doesn’t want to understand, that for patients like Rick Laporte (story, Windsor Star, Nov.19, 2007), Detroit was the only place he could have life-saving heart surgery, because in Windsor, Ontario, Canada - across the river from Detroit - universal medicare failed to provide the required facilities, and offered no hope, for saving him. The government–run monopoly, failing to deliver medical treatment promises, was forced to send Laporte (as it does countless others) to the U.S. to obtain the “medicare” which couldn’t be found in Canada.

“All the studies have shown with emergencies that, if you need help, you get the help right away”, bleats Michael Moore. What meds is this chump on? What flicking “studies” helped Laporte? He was ‘helped right away’, Mike: IN THE STATES! But who cares about actual patients, right, Mr. Michael Moore, when you’ve got a political election agenda to fulfil?

“But the Canadian system, beginning with (Brian) Mulroney, has been under-funded and that’s the problem”, declares Moore, the knowledgeable savant of all things Canadian. Mulroney?!? What is the star of “Dude, where’s my brain?” flickin’ talkin’ about?? Under-funding? Canada's ‘central-plan-and-control health-system’ is not under-funded, it’s inefficient in how it allocates and spends its given budgets. Our medical healthcare monopoly’s systemic, built-in, self-defeating characteristic is its inherent unsustainability: medicare is designed to fail.

And, how much universal health system “funding” would Moore recommend is appropriate, anyway? What “studies” will he pull from his ass to demonstrate “universality’s” break-even point (if there can even be such a thing)?

Does Moore understand that Ontario’s premier Dalton McGuinty admitted (Sept.20, 2007, CTV) that Ontario spends 50% of all government spending just on healthcare? (How much more taxes does Moore think we can pay?) And, does Moore understand that Ontario ALSO has a $3 billion a year new health-tax, yet Ontario also has a cozy $2.3 billion dollar budget surplus? Does Moore understand Ontarians go to the States for treatment? Does Moore not find these figures rather incongruous? 'See, I-told-you-so' Moore would be happy if an evil private company was operating in this fashion, yet this is how government – Moore’s preferred solution - runs health-care in Canada.

Moore thinks, as does the Canadian socialist Roy Romanow, that all we need to do is just dump more money into our (allegedly cash-starved) broken system. Yet, Moore and other lefties cite that the great benefit of “universal health-care” is its supposed low-costs – that is until they are faced with the reality of what universal low-costs actually deliver (mediocrity), at which point the mantra changes, you see, and suddenly, they demand MORE TAX MONEY to sustain a systemically-flawed system (which was originally so gloriously low-cost). Bait-and-switch, indeed.

Kirkland’s article closes with vintage Moore linking Canada’s paltry healthcare system to the war in Iraq, (Seven degrees of paranoia?) saying American people are “not going to listen to Bush anymore” (Well, Mike, you’re right on one level, after all, his second term is drawing near. But, wassat gotta do with healthcare, Dude? “I think the American people get it now.” (You mean, the two-term limit? Or, that your film, as Kirkland notes, is an “agitprop documentary”?) “I don’t think they’re going to be as snookered and hoodwinked as they were with Iraq and the other things Bush did in his first years.” (Like that Bush never delivered the universal healthcare which he never promised to deliver? Or, that Americans WON’T BE SNOOKERED AND HOODWINKED into state-run monopoly medicare by Hollywood propaganda apparatchiks?)

Speaking of switching and baiting on health-care, I had an message from Liberal writer Scott Tribe on Sept.17, 2007: “Would you prefer the American system where 51 million Americans are uninsured, and where others fear of getting seriously ill because it might force them into bankruptcy? The heath-care system has its problems up here, to be sure.. but I look at the alternative down there, and I say, no thanks.”

The alternative down there”, Scott, is where Ontarians are heading to - because WE HAVE NO ALTERNATIVE up here; but to be sure, ask Liberal MP Belinda Stronach.

(As MikeS posted on Get Me Outta Here (Sept.19, 2007) regarding Stronach and Canada’s health system: “Well, of course the system is good . . . until you get really sick. Read the comments, which are expressing sympathy for her and describing this as a personal matter. I agree, it is. I agree, she should seek out the best care she can get. I don’t have any issue whatsoever with Ms. Stronach doing whatever she can to battle her breast cancer.
My issue is not with her at all. It’s with the Moore-ons and socialists. If we had a Candian-style system in this country, Belinda Stronach might be dead. And no matter how liberal she is, I think she—I think everyone—should have the opportunity to seek out the best care they can get without the government looking over their shoulder worrying that it’s not cost-effective. Yes, some people, like Ms. Stronach, will get better care than the rest of us. But that will happen no matter what system do we have. Which would you rather play a bigger role in the quality of care you get: your money or your political connections?”

Like Moore, who tries to glorify Canada’s broken system, Canadian Liberals enjoy demonizing the American system.

I’m wondering: Would you rather be broke, but alive? Or, would you settle for being sick and waiting in line for health-care in Canada? And the stats on bankruptcy are debatable, as are the stats on the uninsured. Ontario has 1.2 million supposedly-“covered” citizens who can’t even find a doctor. What’s not disputable is that for many patients, Canada has become a virtual “medicare-free” zone, where our promised health-care is delivered in the States. This is viewed by Liberals as a victory for our authoritarian, no-patient-choice monopoly system.

When Scott Tribe ejaculates his Liberal semantics, he deflects the equally valid point I repeatedly try to make: Canadians fear getting seriously ill and not having any timely treatment available to them in this country when they need it.

To illustrate how Tribe’s position is not dissimilar to mine, except for the Tommy Douglas part, here’s a look at what he blogged two years ago, Dec.6, 2005, (post-Chaoulli, pre-Lindsay McCreith, pre-Shona Holmes, pre Suzanne Aucoin, pre Rick Laporte, pre-Jepp quads, pre-Belinda Stronach):

“My own views on the matter are this: I support the concept of Universality. I am proud that Tommy Douglas was named "Greatest Canadian" for his innovation in bringing in a "made-in-Canada" solution to health-care. The system has generally served us well since its invention, and a few years ago I'd be dead set against changing one iota of the program. But I have seen in the news the stories about wait-times for surgery - of people forced to go to the US because they couldnt get an operation for many months. I have seen in the very community I live in a massive shortage of doctors - no doctors want to come here, and no general practitioners are taking new patients. People who have no family doctor are forced to go to the Emergency Room to be looked on for even the most basic of complaints. The waiting list to see a GP even if you are a patient who has a doctor is several weeks. The local hospital is forced to engage in cost-cutting measures to meet their budgets, meaning whole departments are being closed in some cases, and layoffs to the nursing staff taking place. Doctors are working 6-7 days a week to catch up and still cant cut into the backlog - and are being worked to the point of exhaustion in the process. The system is not working the way it was originally designed. I don't believe throwing money at it like the Federal Government and Provincial Governments are doing is going to help - particularly when the majority of the money is backloaded at the end of the 10 years it was designed to be allocated. I agree with the NDP and (gasp)Conservatives when they say something needs to be done sooner. Therefore, I am not entirely unhappy with the Supreme Court decision, because perhaps this will force the various governments to look seriously at reforms beyond just throwing money at the system. Too often our country gets bogged down in fearing a slide to the US style of health-care. I don't think that will ever happen, and I think any politician or party advocating that would face instant annihilation at the polls. What we should be doing however, is looking at systems like France (#1 ranked health care setup/system in the world by the OECD - Canada is ranked #30, the US #37) or the Scandinavian countries, or Switzerland or Austria. That's who we should be trying to emulate; they all have higher ranked systems than ours with private two-tier medical setups, yet their public health systems are excellent.

If the Conservative Party wants to take on the Liberals at health-care, it has the perfect opportunity to do so by advocating one of these European-style systems and pointing out where they are ranked (ahead of us), and saying its time we stopped being content with our system being ahead of the US's, and work to get ourselves up closer to France. Let's stop pretending "two-tier" is a bad word. It works fine in Europe without sacrificing universality and it works better, so why not examine bringing some or all aspects of it here?...

There is already two-tier health care in this country...I think the best way to handle it is if rich people want to get special private care they should be allowed to, but there should be a 100% tax on any procedure they have done that goes directly into the health care system - that way one spot on the waiting list is effectively knocked off for every private medical procedure done in Canada. This would either help out our system by reducing waiting lists or get rid of Private Health Care altogether because no one wants to pay double when they can fly somewhere else and get it cheaper. This solution would also effectively get around the court ruling as the government wouldn’t be banning these operations - they would simply be taxing them, something that is already done on every private service in Canada anyway. If this proposal were adopted there should also be strict restrictions placed on this new system so that hospitals get first priority when it comes to equipment, doctors, nurses, etc. These facilities should also be made available to handle overload in cases of a disaster…

This doesn't have to be and shouldnt be a partisan issue.It doesn't have to be a Canadian vs. American health-care issue. It's time to have a serious look at other systems who have private-care but still have good Universal health care, and see if we can't use what they have to reform our system to shorten the waiting lists and to get rid of the doctor shortages here.”

Tribe agrees “the system is not working the way it was originally designed”. But does he agree that its original design was a congenitally flawed shell-game in the first place, designed to placate the electorate, postponing reality for a decade or two by kiting the bills? This Liberal’s typical big-government solution – to make up for another failed big-government solution - : charge a 100% tax on private healthcare! Um, Scott…patients are already paying twice for the privilege – even though they may get treatment privately, they are still paying all of our already-existing health-related taxes…while receiving nothing in return. At least if we had health-care vouchers, patients would have more choice. Tribe's proposed levy is not even a health tax, it is purely a Sickness Tax.

Tribe “gasp” agrees with Conservatives that something must be done. Yes, but the only “something” we ever end up doing, is talk political polemics while patients suffer in a system eternally condemned to perpetual discussion. How many patients have suffered since Tribe wrote his 2005 post? How many honest Liberals have decided to rock the boat and openly contradict themselves, admitting that their fanatically-lauded single-tier health monopoly, has always been a failed economic and social construct?? Not many…they suffer from Liberal healthcare duplicity, as evidenced in my earlier blog of the same title. Although Liberals like Tribe claim to have seen the light in 2005, I still get his email in 2007, predictably bashing the States, when in fact, the issue is Canada’s creaking, jerry-rigged health-care monopoly.

Liberals thrive on uninformed jokers like Michael Moore decanting about Mulroney, when for a decade – after Mulroney – it was Liberal Jean Chretien, along with then finance minister and future Prime Minister Paul Martin, who cut transfer payments to the provinces, directly affecting health care programs.

The non-partisan way for true reformers (even including Liberals), not posers, is to call for the abolishment of the Liberal–instituted federal Canada Health Act, and in Ontario, of the Liberal-instituted Commitment To The Future of Medicare Act. These acts are the status-quo impediment to change, which even some Liberals claim to see. Too bad Liberal Pierre Pettigrew was castigated by his own party when he dared even mention health care reform – and that was just for delivery-improvements within the existing system! So the Liberal rhetoric for “change” – whatever that means in their definition – ultimately simply distills to only talking about change.

What ‘future of medicare’ will we be ‘committed’ (or more aptly, "condemned") to in Ontario, if, unlike with Quebec’s Chaoulli in 2005, the court rules against the McCreith/Holmes charter challenge? All that the Ontario Liberals have done is maintain the status-quo, boasting of medicare’s greatness while occasionally smearing the United States, and then engaging in healthcare rendition by exporting Ontario patients to the Americans for treatment. Successfully defending this charter challenge would only bring bad news for Ontario's ill.

I invite all political tribes to demand of their leaders, federally and provincially, that they stop making two-tier a partisan issue.

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