On Canada's Health-Care System

Canada and America provides envious health care facilities. We people looks Canada as heaven for its being a social welfare state. It is important that these countries could maintain their facilities in the long run.

"Canada is ranked 14th for life expectancy, vs the US at 45. There are 31 countries that separate their life expectancy and ours, but we share a common border."

Perhaps there's an inverse relation between quality of healthcare and life expectancy. Perhaps having a health care system where getting treatment is relatively easy is a moral hazard that encourages dangerous behavior.

Gil,

Some day, perhaps, we will meet and I can give you a quick free lesson in how to read.

I agreed with you about the free market, you seemed to have missed that.

Then I presented my ideas on why I posted the link, which was to present the idea that healthcare aka English style was going to include gatekeepers. Then I offered my opinion that gatekeepers aren't a good idea.

And, of course I presented et.al. with the understanding that gatekeepers and gatekeeping (based strictly on the gatekeeper's arbitrary decisions) in health care is a uniquely socialistic idea.

Now most intelligent people understand that all socialistic ideas are bad, inherently bad, because they are socialistic.

See what a wonderful thing communication is?

Ackermann,

In England there are government employees going door to door peeking in peoples' fridges and making sure they make proper use of leftovers.


In Japan employers are fined when their employees' waistlines exceed certain predefined limits.


There is precedence.

K ACKERMANN.

THEY DO.

SEE ENGLAND

Doctor says to get more exercise and change your diet, and you don't do it, you get punished.

Doctor says quit smoking and drinking, you don't do it you get forced rehab.

They don't do that anywhere else, but point taken.

They will plan our meals, monitor the air around our heads, make us have regular bowel movements, perform a blood test before sex, and then when we start to die, Bill Frisk will hook us up to life support and Dick Cheney can hit us with the electric cattle prod every once in a while to see if we can still twitch.

I can see it now.

Single payer system will cure obesity, diabetes, alcoholism, lung cancer, heart disease and all other preventable conditions.


How?


Easy, make it a crime to go against doctor's orders.

Doctor says to get more exercise and change your diet, and you don't do it, you get punished.

Doctor says quit smoking and drinking, you don't do it you get forced rehab.

All preventable illnesses will be cured!

"The USA spends 15% of our GDP on health care while Canada spends 10%. So I guess somehow that makes Canada less efficient then us???"

Complete non sequitur. The article is not a comparison of expenditures; it's a comparison of value.

Canadians are getting ripped off at 10%, since other countries do better than Canada at lower percentages of GDP.

Since you undoubtedly already know that, this would be a great opportunity for you to explore why you need to resort to deception and deflection to make your case. Why are you so dishonest? If your arguments are all lies, is is any wonder that your policies are perceived as theft?

That we pay more for care means nothing without a comparison of quality. It could be as simple as Canadians not having sufficient personal incomes, to pay for the care they'd like to buy, after paying for the care they're required to buy.

Good article but it only begins to scratch at the surface.

Most folks who can afford it, have US medical insurance if something serious happens. They would get private insurance in Canada but that's against the law. Because in a society where all is equal and just, it's plain unfair for one person to die while waiting in line and another to live.

Wait times are only the beginning.

The entire system is run pretty much like a government agency. In Montreal a man walked into the emergency room with chest pains, was told to go out and call 911. The guy walked out and died just outside the hospital.

It turns out that amidst all the magic of universal heath care the rationing continues:

Old people can only see their doctors a limited time per year. Should you happen not to feel well at the wrong time of year, your cardiologist will tell you to "go to the emergency room".

Then you have to try to find a doctor.

The law limits the amount of patients a doctor can see. Two thing result from this:

A. It is very difficult to get seen by doctors still living here.

B. We're losing doctors.

Most kids worth their salt finishing med school pick up and leave for the greener pastures of The U.S. where they make several times more money than they would up here. So the number of doctors is dwindling and those who are left tend to be older who don't want to leave their elderly parents and the like.

Also, The ones that do remain, are not as good as doctors elsewhere and they have zero incentive to be any better because their income will remain identical. So both quantity and quality are affected.

Of course the solution for all this is simple: Extend wait times and let the fittest survive.

Huh, vidyohs? I was simply postulating a bit of free market healthcare. If healthcare is left to the market then there aren't Guardians to determine who get what but simply whether people can afford the treatment to get well. 'Tis hard to understand what you write sometimes much less do I have a donkey to gamble with.

"Vidyohs links an article where the British specialists don't want waste resources on those they deem 'not worthy'. Imagine a old drunk needing a liver transplant - if the drunk can afford to pay for the whole shebang then he's gets the liver. Similarly, why should a person, who has spent their spare income on cigarettes, act surprised when they get cancer yet can't afford any treatment? Posted by: Gil | May 12, 2009 1:31:47 AM"

Surprising what you assume, Gil. I linked but did not give an opinion.

Essentially I think that your old drunk, if he can afford it, should receive the care he can pay for; and conversely I think the smoker who can't pay for his treatment should be buried by his family and sad words spoken over his inability to support his habit, his sickness, and any treatment.

You see, we aren't so far off, so far.

Where we differ is on the gatekeepers.

The gatekeepers want to shut the gate on those that can afford and those who can not afford indiscriminately, and then to ration treatment as they see fit.

You bet your ass, Gil, that the gatekeepers will never be deemed "unworthy" of treatment and therein lies the abuse that inevitably arises in any system where someone decides for others what they will have or will not have.

OOOOOOH, its great to be in with the in crowd!" Seems like a good song in there, eh?

If the NHS has gone ahead and implemented the concept of ignoring the unworthy and reserving the treatment for the worthy, it would be interesting to see over the last year if any of your house of Lords, or of the commons, ever are deemed unworthy, and certainly to check and see how your aristocrats stack up on the worthy/unworthy scale.

The crux of the matter, Gil, is that decision maker of worthy/unworthy won't be you or your wallet. That crux of the matter is the simple reason we intelligent people hate socialism and it evangelicals as much as we do.

muirgeo 05/12/09 @ 2:02:19 AM

"The USA spends 15% of our GDP on health care while Canada spends 10%. So I guess somehow that makes Canada less efficient then us???"

Only you could make such a declaration.

S. Andrews,

I'm not the one who's arguing 10 is more the 15. I'm not the one uncomfortable with the facts.

The troll keeps telling everyone to move out of this country. If the troll thinks that Canada is so wonderful, Why doesn't the troll move to Canada? I wouldn't have asked that question if the troll hadn't asked all the libertarians to leave.

Hosts made it clear that troll doesn't have anything useful to say. Doesn't the troll have no shame?

Look how the troll started infesting a new thread, as soon as some uncomfortable questions were asked of him in another thread.

The way troll ended his comment gives you the impression that he is not interested in any of this, then I wonder why he is so obsessed with this blog.

"Canadians receive poor value for health-care dollars"

The USA spends 15% of our GDP on health care while Canada spends 10%. So I guess somehow that makes Canada less efficient then us??? No they are just one of the least efficient countries that HAS universal health care. Most are even less expensive.

But of course people are posting what a disaster it will be for us to have universal health care because of the cost. No care is given for the facts but bringing them up is obviously trolling. Whatever....

Why does the healthcare topic get thrown around, comparing one country's healthcare to another, without getting to the heart of the matter? Should healthcare be left to the free market? Or, yes, have single system - users pay up. Vidyohs links an article where the British specialists don't want waste resources on those they deem 'not worthy'. Imagine a old drunk needing a liver transplant - if the drunk can afford to pay for the whole shebang then he's gets the liver. Similarly, why should a person, who has spent their spare income on cigarettes, act surprised when they get cancer yet can't afford any treatment? At least in the free market there'll be all sorts of pain relievers that were previously illegal (e.g. heroin) to help as the cancer spreads. Who knows? In a free market where people who engage in unhealthful habits (e.g. getting fat, smoking, drinking, etc.) find out they're in trouble and can't afford treatment - they'll act as role model for the next generation to be healthy so they don't go broke or dead in middle age.

Canada is ranked 14th for life expectancy, vs the US at 45. There are 31 countries that separate their life expectancy and ours, but we share a common border.

Do you think ending the war on drugs will stop criminal violence on the streets? Will that help send the numbers higher?

U.S.A has a wider genetic mix of people than Canada.

"I'm going to refrain from an easy line of attack as to any bias on the part of the author.

I'll just look at one metric:

Canada is ranked 14th for life expectancy, vs the US at 45. There are 31 countries that separate their life expectancy and ours, but we share a common border."

K Ackermann

Yes, we are separated by a border but there are two very different countries on each side, just like with Mexico to the south. I would like to see how life expectancy in Minnesota or Maine or Vermont compares with Canada.

I would like to point out that health care or more to the point, medical care, it is just one factor that influences in the life expectancy. Other life style issues influence just as much, anything from food and exercise habits to violent crime.

To me this comparison is like the hang wringing about the fact that the population of some northern European countries like the Netherlands are now taller than the "white" population of the U.S. Even though "Caucasians" in the U.S. comprise any one from or with ancestors from anywhere from Norway to Egypt and the Middle East, except Spanish speakers to be compared with member exclusively from the Nordic race which is one of the tallest in the world.

How survival rates from illnesses that require high tech medical care, like cancer, compares between Canada and the U. S.? That would be a better indicator as to the quality of medical care in both countries.

wow... change that seas to sees.

"Canada is ranked 14th for life expectancy, vs the US at 45."

Life expectancy is not determined solely by the health care system, unless you think that homicide, lifestyles, and genetics are the purview of that system.

And if you do, and you really want to be #1, then surely you'll soon be advocating "health care" measures like repeal of the second amendment, institution of a system of rewards and punishments to ensure that people comply with the most up-to-date lifestyle requirements, and forced sterilization for purposes of cleaning up the gene pool.

"Canada is ranked 14th for life expectancy, vs the US at 45. There are 31 countries that separate their life expectancy and ours, but we share a common border."

-K Ackermann

This is a typical argument of those in favor of Canadian style healthcare, but is extremely misguided.

First, we in the US kill each other more than the Canadians do. Secondly, we in the US tend to be much fatter than our Canadian neighbors. This leads to higher rates of heart disease and other related health issues.

Neither of these (amongst other) issues would be resolved by copying the Canadian system.

To just say Canadians live longer and therefore govt. run healthcare must great is to judge a book by its cover.

My sister (not a libertarian) works in a Seattle area hospital and seas plenty of Canadians.

Many Canadians come to the US to receive care, therefore Canadian healthcare must really suck.

The Fraser institute is the Canadian equivalent of the Cato Institute - no bias there. So do Canadian's suffer from 'false consciousness' in their general opposition to American style health care?

I'm going to refrain from an easy line of attack as to any bias on the part of the author.

I'll just look at one metric:

Canada is ranked 14th for life expectancy, vs the US at 45. There are 31 countries that separate their life expectancy and ours, but we share a common border.

Pingry, again, you nailed it.

One of the biggest issues is healthcare rationing. Something rations it. Whether it's cost, wait times, literal rationing (it's done sometimes for elective operations) or some other method.

It actually blows my mind that the politicians that support it either don't consider this or ignore it for whatever reason.

The one bone I will pick with the statement is that I think that healthcare really behaves like any other market. Granted, the different payment systems and methods of insurance do add some complexity in determining market prices and incentives. But I think most of the "complications" of healthcare is just smoke being blown into the air to turn HC into a topic that everyone can get their fingers into and claim rights and needs around. At the end of the day, to the individual, it's simply a bunch of decisions based on risk, and it's being payed for by a fragmented payment system. It does add complication, but not because it's inherently more difficult, but simply because of the constructions.

If you had to think about food purchase plans every time you went to the supermarket, and consider which brands and types of food were covered based on your plan and your job, with partial subsidies from the government and deductibles and copays, food would start to get pretty complicated, and I imagine that there'd be a couple proponents of single payor universal foodcare.

I think JasperPants and many others would make the correct argument that, all else aside, more taxes would need to raised to finance Canadian-style National Health Insurance (NHI) for everyone. This would almost certainly entail higher marginal tax rates for certain groups and businesses, if not all of them.

Now, the economics of healthcare is quite a bizarre thing (and hell to 'reform') because it involves many peculiarities not present in most other markets. And this provides a perfect example of Bastiat's excellent observation of "that which is seen and that which is unseen."

Specifically, people can see that there are higher taxes in Canada, in part, to finance their NHI system. And, it's safe to say that the same would happen in the U.S., all else aside. And I think many people are certainly concerned about that.

However, what people do not see is that the ridiculously higher percentage of real GDP we spend on healthcare, relative to other nations, is already a tax on us also - albeit a hidden (unseen) tax. As healthcare costs increase faster than inflation, most people cannot see that real wage growth grows at a slower level. This acts as a tax on labor because a growing proportion of any given worker's MRP is composed of healthcare benefits, rather than wages.

In addition, like many areas of economics, there is a tradeoff between equity and efficiency. That is, to get more access to healthcare for a greater number of people entails higher costs (all else aside, of course) which means less efficiency because the marginal costs increase relative to the marginal benefits of the next unit produced. Thus, we move to a new equilibrium in which the degree of allocative inefficiency actually gets even worse!

And, of course, there is no scientific way to determine whether equity is better or worse than efficiency.

Finally, I would like to note that I think that rationing healthcare by queuing would not be tolerated in the U.S. I reckon that there is a cultural tendency here to have access to healthcare 'on demand'. What I suspect will happen is that the vested interests will lobby hard to keep the status quo, Obama and the Democrats will make some serious concessions as they use their newfound campaign donations to battle the "fiscally conservative" Republican party which will attack them hard on the budget issue in four years.

I really think that U.S. healthcare system will not be radically altered, for better or worse. After all, we tried this stuff back in 1993 with the Clinton administration, and it got scrapped pretty quickly.

I could be wrong about that.....but I believe that everyone is starting to see that Obama is not about "change you can believe in," he's just another slimy politician who happens to be better at generating hype and suckering people through a teleprompter than others.

Well, the honeymoon is over Barry, and the Presidency isn't quite what you thought it would be.

Jasper, that's not even the half of it.

Canada has managed through provincial control and monopsonistic purchasing to keep the prices surprisingly low for healthcare. Despite Canadian HC being universal across all provinces, and despite the geographical spread, and despite all of the other issues that would increase price, the government STILL pays half of what the US government pays for extremely limited service.

Think about that for a minute. The US government pays twice what the Canadian government does for the medicare services they provide RIGHT NOW. This is ignoring all private and employer-funded insurance plans as well as private payments for procedures.

http://www.telegraph.co.uk/news/uknews/1576704/Dont-treat-the-old-and-unhealthy-say-doctors.html

Here is an article about Britain's Natl Health Svc.

Oddly enough, strangely enough, perhaps not, we are hearing the same rumblings coming out of Obama and his minions.

Last Sunday's Houston Chronicle also had an article by Ellen Goodman that expressed basically the same idea.

If single payer is forced on us then this decision is going to be made by those gate keepers we do not know and who do not care about us as individuals.

I think the momentum is with Obama on Universal health care. One way or another, out friends south of the border are going to flirt with this ideological journey.

I think it will rip your country apart...perhaps even leading to civil war. Why? The cost and the unbeliveable agressiveness agents of the new system will pursue their public health goals.

Imagine if Washington mandated the States to have a minimum standard of care at no cost to all. The Feds would pay half, and the States must fund the other half. How much will income taxes have to go up to pay for this?

In Canada, if you earn 100K, you will pay about 45K in income taxes. Provincial taxes are half of Federal taxes. This is your future, under a single payer system.

What about preventative care measures? In the name of public health, mandates for weight, smoking, nutrition etc will be commonplace. Nanny state? Under Universal health care, you haven't seen anything yet.

In the short term, I think it would be best for market-oriented folk to try and carve out the possibility that private care would still be able to be legally obtained (it is not in Canada for major medical procedures), and wait for your new system to implode under its own weight, if indeed you go the full single payer model.

Time will tell.

Oh, Pingry, Third line and beyond of the last comment wasn't in reference to yours... I should have made a more obvious subject change.

Pingry,

I have to say, I think you're entirely right.

But all of the campaigning they do against the existing system, I haven't seen the Frasier institute do any kind of root cause analysis (though i may have missed it). I'm not being an apologetic... Two posts ago, I just decried the wait times that occur. But it's more complicated that just "they pay a lot of money, and they only have 2.2 doctors per thousand."

The incentives around emergency and diagnostics are totally broken, I agree. But they glaze over factors like geographic distributions of population, elective operations performed, and community care centers (walk-in and appointment-based clinics) that are extremely dollar-efficient.

I wonder when the last time a doctor in Germany went to work in a brush plane like in the Yukon, or when they had to pay a doctor to work year round in the Northwest Territories.

This is the consequence of Universal Healthcare in the Canadian environment. Make an argument against it, by all means. There are many. But ignoring the subtle influence of the many root causes tends to oversimplify the argument in a way that results in discussions about C+I+G being causative to growth.

I am getting worried about all of the rumblings about single-payer in America. If I hear that new MSNBC idiot Ed Sullivan say one more time that the Democrats have a plan to control costs and improve the quality of health care, well, I'll change the channel. But seriously, I think single-payer would be disasterous in America.

I am getting worried about all of the rumblings about single-payer in America. If I hear that new MSNBC idiot Ed Sullivan say one more time that the Democrats have a plan to control costs and improve the quality of health care, well, I'll change the channel. But seriously, I think single-payer would be disasterous in America.

Excellent.

A good article showing that extensive waiting periods are the way in which some countries decide to 'control' costs in their healthcare system.

Now, in the US, we have profound increases in the cost of healthcare because, rather than rationing by queuing, we have rationing by prices. The massive increases in healthcare costs in the US, adjusted for quality and measured in dollars, is similar to the increases in healthcare costs incurred in the rationing by queuing approach we see in Canada. That is, the costs are expressed differently in different countries.

This, of course, is mainly due to the third party payer model. And, this third party payer model in the US now has the present value of medicare's expected future deficits on the order of $75 Trillion!

In any event, there is no 'best' healthcare system........there are only costs and benefits at the margin.

--Pingry