The most important feature of the Fraser Institute’s assessment of Canadian health care, released this week, is that it does not rank our care versus that of the United States.
It is always the slam against those who seek to show that Canadian health care is less than the best, that their true motive is two-tiered, American-style, for-profit health care.
Jack Layton, the NDP leader, levelled this charge against the Fraser study, despite the fact the American system does not appear in the comparisons. Layton told CTV News the Vancouver think-tank has only ever wanted to impose American health care on Canada. “But that’s not what Canadians want,” Layton said. “And the NDP is standing with Canadians.”
Nice. Completely irrelevant, but nice. The NDP intends to link arms with Canadians…and march completely off the topic.
That’s the way the debate is always conducted in this country. Anytime someone mentions health care reform (as opposed to throwing scads more public money at the system), politicians, health care unions, academics and socialist lobbies scream “Two-tiered!!” “American!!!” They do this as much to stifle debate as to prevent private innovation in health care.
But, the Fraser study compares Canada only to other industrialized nations with “universal access” medicare systems, countries in which government ensures everyone gets treated regardless of their ability to pay.
Canada is compared only with Switzerland, Sweden, Australia, the Netherlands, France, Germany, Japan, the U.K. and the 18 other member nations of the OECD that guarantee government-funded care.
Among these countries, Canada spends the most per capita. After adjusting for the age of our population, we spend a greater percentage of our GDP (nearly 11 per cent) on government-run health care than any other industrialized nation on earth. (It is important to adjust for age because seniors consume a disproportionate amount of health care and Canada has a relatively young population.)
Yet, despite all our spending, Canada ranks in the middle of the pack in terms of health outcomes. We are 14th of 27 for “disability-free life expectancy” (years lived without debilitating pain or physical limits on freedom of mobility). France is first, Australia second and Spain third. We are 16th in infant mortality. Iceland is first, Japan second and Finland third.
Per one million residents, we have only one-fifth the number of MRIs as the Japanese — (although the French don’t have many either, and their health outcomes are significantly better than ours, so not all factors compared in the study have a direct, individual correlation to health outcomes. Overall, though, a pattern emerges).
Canada is 17th in access to CT scanners. In other words, Canada’s performance is mediocre. We don’t get much healthier for all the money that is taxed away from us and spent on health care, despite the delusions we constantly tell one another about how “our system is the best in the world.”
We have scare-mongered ourselves into paralysis. We have permitted ourselves to believe that any private delivery of health care — any at all — jeopardizes universal access. We have confused delivery with access.
We have allowed demagoguing politicians and haranguing friends of socialized medicine to cow us into believing that unless all health care is provided by the state, affordable care will be unavailable when we or our families need it.
We confuse health care funding with health outcomes. If we merely spend a lot, surely that must mean we have the best possible health system, we reassure ourselves. And lots of spending might well mean we have a great system. But a robust system is not synonymous with a healthy population.
If we accept that the twin principles of a sensible and moral health system are a) everyone has a right to timely care, regardless of their ability to pay, and b) the best measure of a system’s proficiency is the health of the population it serves, then Canada’s health system gets excellent grades on the first criterion, but barely passing ones on the second.
We have become so obsessed with making sure our system is “there when we need it,” that we have skimmed over the need to ensure it makes us better when we’re sick, and does so quickly.
The Fraser study found that among universal-access health systems, Canada’s was the only one that forbade the private purchase of health services, the provision of comprehensive private insurance, the establishment of private hospitals and the charging of user fees. Some banned one or more, but not all four.
Our system, instead, seems designed not first and foremost to make us feel better when we’re ill, but rather to permit us to feel superior to the Americans.
Will more government spending improve health outcomes? No. Our governments already spend the most in the OECD.
What’s needed is for us to get over the notion that private provision of care taints a health system. All the other countries with universal-access systems in which health outcomes are better than ours realize a bit of private competition and innovation, mixed in with assurances of care for all, produces the best results for patients. The “system” is secondary. It’s time for Canadians to catch on to this, too.