Health care in Canada and Great Britain is not better than ours in terms of quality of care and in fact does not approach equivalence with ours.

Our new President has set aside more than $600 billion dollars as a "down payment" toward remaking the US health care system.  As liberals search for a model upon which to base our new socialized system they look toward other countries whose populations and demographic realities are very different from ours. It is very feasible to build upon the excellent, though admittedly flawed system we currently have by adopting changes that would reduce government mandated oppressive regulations passed on from Medicare to private insurance providers. This would allow the free market to provide a cost effective health care system for all Americans.  However, true to form, liberals want to throw out the baby with the bath water and spend trillions of dollars on a government controlled bureaucracy that will be inefficient and provide inferior care.  

Publicly funded health care in the US insured some 84 million people in 2007. These data were released in June of 2008 and are the latest full year of data available through the US government as of this writing. The Medicare system in the United States, covering the over age 65 crowd and the disabled with government funded single-payer health care, includes some 44 million patients;  about 37 million seniors and nearly 7 million disabled persons.  Medicaid for the poor covers nearly 40 million additional persons. This "single-payer" system is almost three times larger than the entire healthcare system of Canada and one and a half times that of the United Kingdom. However, in the USA, although government pays for the majority of medical services for enrollees the services are usually provided through private health care providers and institutions.

If we are going to actually look toward the health care systems of other countries we need to answer some basic questions: 1. Whether in fact the health-care in that other country is equivalent to or better than ours in terms of quality of care. 2. Whether another health care system affords care at a significantly lower cost. There seems to be little point in desiring a system of care inferior to ours. Similarly, if it will require entirely dismantling and remaking our system, it makes little sense, even to the liberal minded, to go through all that trouble if we don't really save any money.

In order to answer the first question, we need to agree on measurement parameters to determine the quality of the health care provided. Institutions such as the US Joint Commission (likely named for the stuff they smoke prior to their inspections), Medicare, the US government, the governments of other countries and the World Health Organization have in the past come up with criteria to determine the quality of health care provided by different systems. The problem is that these criteria are usually those easiest to measure and may not tell the complete story.  There are several criteria by which the World Health Organization (WHO) has measured the "quality" of health care systems. It is interesting to note that the WHO last evaluated healthcare systems in the year 2000, deciding at that time that it was an impossible task to do so because of the complexities involved. Nonetheless, prior to that and despite the impossibility of the task, it attempted to do so.

One of the problems with comparisons such as this is that the information from countries with socialized medicine is supplied by the organizations that operate the health-care systems being evaluated. That's rather like the University student giving himself the examination and reporting the results to the professor. While this would be a welcome change by many students it would probably not be considered appropriate in most universities. However, for the sake of our review we will look over the previously used World Health Organization ranking of health-care systems.

In rankings of health care by the WHO in 2000, Britain ranked 18^th, Canada 30^th and the US ranked 37^th.  Another ranking compared the performance of the health care systems in different countries, based on eight criteria. The US ranked number one in terms of "responsiveness" and, of course, high cost. Not unexpectedly, given that the WHO is a United Nations subsidiary, in the most important parameter, overall health, the US ranked well behind other advanced, benevolent and civic minded countries such as Iran, Tunisia and China.  The US ranked 24^th in terms of healthy life expectancy, (The average number of years that a person can expect to live in "full health" by taking into account years lived in less than full health due to disease and/or injury). One interesting note among many is that China ranked above the US in overall health, yet trailed behind significantly in life expectancy. Logic would conclude that it would be unlikely that a large percentage of Chinese who were healthier than Americans would prematurely die of good health. Therefore, we can see the data are very imperfect. 

What can we glean from the comparison and a review of the above data?

1. According to the WHO, the US has a less than optimal health care system in most respects.

2. The US spends more money on health care than other countries.

However, for good or ill, the US uses more per capita of electricity, oil and just about everything else than other countries as well. The US population is 306 million people with a GDP about equal to that of the entire European Union, which has a population of 495 million people. The U.S. uses 20 million barrels of oil a day while the European Union uses 14 million. That is .1 barrels a day per capita for the U.S. and .03 barrels a day per capita for the EU, or a consumption of three times the oil per capita. We use 1.6 times the oil per capita that Canada uses and it's colder up there. I am not condoning this level of consumption, but merely wish to point out that it is not in a vacuum that we spend more on health care. If we spend three times per capita on everything else than the E.U. does and 1.6 times that of Canada should not the ratio spent on health care be expected to be commensurate with those numbers?

Many of the measurements used to compare health care systems, such as life expectancy and infant mortality, cannot be used as a measure of the quality of health care systems because they depend on too many other variables. Japan, with the highest average life expectancy of major countries, is a racially homogeneous society with healthier food habits, close family ties and a great reverence for age. These are factors that could significantly contribute to a longer life expectancy. There is no evidence that their health care system is singularly responsible for the higher life expectancy. There are many other social, demographic and reporting differences that contribute to the statistics used to compare health systems.

The 2009 projected life expectancy data shows some interesting results. The US is apparently 50^th in life expectancy, behind countries such as Jordan and Portugal. However, a much better comparison would be that between the European Union and the USA. The difference in life expectancy is half a year, slight advantage EU.  A comparison of Luxembourg, with a homogenous population of 491,000, to the US, a very heterogeneous society, is hardly fair. A better comparison would be Luxembourg with Hawaii.  The advantage goes to Hawaii.

Americans in their teens and 20's are, sadly, more likely to die  in gang related activity and accidents than their counterparts in Canada and the United Kingdom. While these factors do affect overall life expectancy, they say nothing about the respective health care systems. Similar arguments can be made for apparent differences in infant mortality. Due to demographic differences, the US has, unfortunately, a higher percentage of women with drug addiction and alcoholism than Canada and this results in neonatal health problems. Additionally, due to the greater availability of maternal and neonatal intensive care services in the US than in Canada or Britain, a greater percentage of babies who would have died just before or at birth are resuscitated in the US. The feeble condition of these babies also accounts for a higher infant mortality rate. Accurate diagnoses, proper management and outcomes measures are interestingly not used in statistical models for comparison of health care systems. Furthermore, as we shall see, statistics can be unintentionally misleading and they can also be purposely used to mislead. 

The US health care system is also erroneously compared to that of other countries as if it were a single "system". But, the US has in effect, broadly speaking a dual system of health care; one "system" refers to private insurance funded health care and the second is publicly (taxpayer) funded and includes Medicare, Medicaid, CHIP (Children's Health Insurance Program and TRICARE, the military health plan. Due to constraints of length and complexity, the numbers given will reflect major costs for usual care and average tax burden and will not examine extended care or special cases specifically. Since we are comparing costs for the most part for 2008, the average exchange rate of $1.00 US to $1.06 Canadian for that time period must be kept in mind. The exchange rates between the British Pound and US dollar have been about the same since 2008.

US costs for Medicare and Medicaid were about $760 billion for 2007.  The figures for 2008 are pending. This included $431 billion for Medicare. The US population covered under Medicare numbered about 37 million seniors and 7 million disabled. The cost was therefore about $362 billion to cover seniors or about $9,783 per covered person, If premium costs to the individual are counted at $1,157 yearly, the cost is $10,940. Further, Medicare enrollees pay about 20% of their health care costs out of pocket, or about $1,956 yearly (This may include supplemental insurance plans).  The per capita cost of care for US senior citizens was therefore about $12,896. Medicare spending grew 7.2 % in 2007, while private health care spending grew by 5.8% to $1.2 trillion in 2007-2008. However, over 130,000 pages of Medicare's punitive regulations, many of which change monthly, are a significant financial drain on US health care, requiring entire well staffed departments in every hospital to deal with this complexity. Therefore, the cost of government funded health care in the US is actually much higher than is statistically apparent because it shifts administrative burdens to the private sector.

There were 205 million people in the US between the ages of birth and 65 covered by private health care at a cost per capita of about $5,853, taking into account the US government figure of $1.2 trillion. However, that private health care cost also included the 20% paid by Medicare patients for their out of pocket expenses, or $72.372 billion. Medicaid spent $329 billion to cover 40 million persons, who paid, conservatively speaking, 10% for out of pocket expenses. Therefore, if Medicaid spent $329 billion, the total cost of care would have been around $366 billion. Ten percent of that would have accounted for "private" spending, or $36.6 billion. A total of at least $109 billion was spent privately by these government health care recipients in 2007 and surely more in 2008, reducing the actual cost of exclusively privately insured persons to about $5,300 per capita, much more in line with Canada and Switzerland. This does not include the amount paid out of pocket by persons in the SCHIP program and TRICARE, which, if deducted from total private spending would reduce the actual cost of private health care even further.

Canada's health care spending reached $171.9 billion dollars in 2008, according to a Canadian government study.  In Canada, senior citizens accounted for nearly 40% of public health care spending and made up about 13% of the population in 2006, projected to have been 14% in 2008. Canadian data show that, on average, care of the elderly cost $9,967 yearly per capita. With a little mathematical trickery, let's see what happens if we take 40% of $171.9 billion and divide by 14% of 33 million people. Canada's 4,600,000 senior citizens cost on average $14,947 yearly. How can we account for the difference? Note that in the same publication, the above figure is given as the "spending by provincial and territorial governments."  We can see how statistics can be misleading. The Canadian figure reflects only government recorded spending and does not reflect the additional cost to individuals, such as the costs for outpatient medications and other treatment not covered under the plans. The statistics for Britain are harder to come by and I was unable to find data specifically for the cost of care for people over age 65.

US health care is often cited as the highest cost as a percentage of GDP in the world. It makes a difference whether the GDP being measured is "nominal" or "purchasing power parity (PPP). The US GDP (PPP) was $14.29 trillion in 2008 and we spent $2.38 trillion, or 16.6% of GDP, on health care. Canada had a GDP (PPP) of $1.378 trillion and spent $171.9 billion in public spending on health care, or 13.2 % of GDP. Canadian figures show a lower number of 10.7% of GDP, but this figure is misleading and using the GDP (PPP), which accounts for purchasing power and therefore does not require exchange rate calculations, as well the Canadian government figure of $171.9 billion Canadian we arrive at the 13.2% figure. The GDP of Great Britain was $2.23 trillion. At $7,900 per capita in 2008, the US does seem to spend more money on health care than any other country. Our costs rose from $7,439 per capita in 2007, a rise of 6.1%, with Medicare spending rising 8% and private health care spending rising 5.3%.

Canadian health care costs rose to $5,190 per capita last year, up 6.4% from 2007.  Canadian health care costs are rising more rapidly than in the US. In 2003, a comparison of Canadian health care costs at $2,998 per capita with US costs of $5,711 per capita shows that Canadian costs were about 53% of those in the US. That proportion has risen from 53% to nearly 66% in five years. While that number may still seem like a substantial savings by the Canadian system, the rate of rise is concerning and will likely increase. The Canadian health care system was implemented in 1962, when the economy was growing significantly faster than that of the US. Projections of future costs were made based upon unrealistic growth expectations.  Current trends in Canadian health care spending also partly reflect the higher percentage of Canadians over age 65. However, they do not take into account money spent by Canadians for health care in the US. About 90% of Canadians live within 100 miles of the Canadian border and some US hospitals are profiting from this.

In Britain, the total cost of health care is difficult to come by. The National Health Service was expected to spend about 100 billion pounds or $155 billion in 2008 with a commensurate rise in the proportion of "national income" to 9.4%. With a population of 61 million the cost per capita of the NHS would be just $2,500, less than half that of Canada's cost. However, ten percent of people in Britain carry private insurance and the cost of this insurance, as well as the cost of much of the privately funded care is not included in the British calculations.

The GDP (Gross Domestic Product) per capita in US dollars was $46,800 for the USA, $39,200 per capita for Canada and $36,600 for Great Britain in 2008.  Comparisons of health care costs as a percentage of GDP usually compare nominal GDP instead of GDP (Purchasing Power Parity) (PPP), which would account for purchasing power differences between countries.  There has been little account by proponents of socialized medicine of health care cost as a percentage of after tax income per capita. For instance, Americans spent more on medication as a percentage of GDP. However, as a percentage of per-capita, after-tax income, the cost burden of prescription drug spending is higher in Canada (2.5 percent in Canada compared to 2.3 percent in the United States).

The average yearly premium for private health insurance in the U.S. was $12,700 for a family of four in 2008. The median income for that family was about $60,000 per year. After FICA, Federal income tax, average state income  tax and the average employee share of the health care premium the family would have a net disposable income of $43,900. That same family in Canada would have a net income of $39,479 after income taxes , pension taxes, and Employment Insurance taxes.  As of this writing, the typical American family therefore has over $4,500 more disposable income yearly compared to their Canadian counterparts.  In the United Kingdom, a family with earnings equal to $60,000 yearly would be left with $37,527 in after tax income following National Insurance tax and  Income taxes.

The Canadian health care system covers basic necessary health care. More extensive plans cost extra. Several provinces charge health care premiums and the number that do so, as well as the cost of those premiums, is expected to rise. Canada has very high taxes on nearly everything else as well, spending 5% more of their GDP in taxes than Americans. Sales tax averaged 4% in the United States, while in Canada sales taxes (GST/HST) averaged about 14%. Americans have a higher purchasing power per capita than Canadians, making their extra $4,500 a year go further. For the British family, purchasing power parity is less than 80% of that in the USA, so we would have to take into account that their net income would purchase less in the UK than in the US. Additionally, there are higher sales taxes (value added tax) of up to 17%. The US family would have more than $6, 300 per year more spendable income than the British family and that money would go farther. The final calculation in terms of the cost of medical care must be made in light of these facts.

Another aspect of health care spending is, of course, overlooked by those who desire socialism. The US health care industry is, by and large, a service oriented free enterprise business. It contributes to the very GDP we use to measure our productivity. That $2.38 trillion in spending went to private hospitals, EMT's, respiratory therapists, doctors, nurses, ambulance services, physical therapists, pharmacies, pharmaceutical companies, durable equipment companies, etc. They in turn spent money on other products and services in the free market. Even if we deduct the $760 billion dollars in taxes used for government funded health care in Medicare and Medicaid, (an erroneous action given the fact that the government does spend for care in the free market), this leaves us with $1.6 trillion in contribution to our GDP from the health care industry. Health care therefore added at least 12% to our GDP. Again these numbers are not exact but do show that the pro-socialized medicine crowd ignores facts not in keeping with their world view.

The positive economic effect of health care on GDP is less important in Canada and the United Kingdom as the hospitals and other service agencies are primarily government owned. They do not earn a profit and they employ government workers, the fastest growing sector of the Canadian economy.  It has been alleged that health care costs the United States 17% of its GDP. We do not use this terminology for any other industry. We do not say that the service industry cost the US 65% of GDP, but that the service industry contributed 65% to the GDP. I may be frustrated with the cost of computers for my medical office. But, when discussing the economy, I must admit that the computer industry contributed to the GDP, even as it contributed to the depletion of my funds. How is it possible then to forget that, in order for me to earn money to purchase the computers, I also provided a service that contributed to the GDP? Again, socialists neglect very important information and use convoluted reasoning.

Generally, Canadians are not covered for many health services, including outpatient prescription drugs (supplemental plans are available in some provinces), physical examinations, prostate specific antigen (PSA) tests, other cancer screening or services of counselors or psychologists that are considered standard in the US. In reality, obtaining even covered services is often difficult. There is no standard as to what constitutes an urgent need for an MRI and though some centers can get patients in quickly, other patients can wait as long as a year. In Britain, services must be approved by a local government board. Many people are refused care that would be standard in the US.

Therefore, the total costs, including hidden costs, to the economy for health care are not substantially lower in Canada and the United Kingdom if all factors are considered, including those that seem to artificially report lower spending. Health care in Canada and the United Kingdom also appears to cost less because there is less availability of advanced treatments. Canadian health care costs are rising faster than those in the US. The current difference in spending is likely less than 3% and this is not a sufficient savings to justify Obama's $600 billion (25% of yearly health care costs) "deposit". Other hidden factors are those that serve to artificially inflate the costs of US privately funded health care, such as the Medicare tactics mentioned above and the high cost of medical litigation.  The burden of medical malpractice lawsuits, which increase the cost of medical care in the US primarily by causing physicians to practice "defensive" medicine and by raising the price of medications, must be addressed. The "tort tax", an interesting concept, was calculated in 2003 to be over $3,000 per year for a family of four. Yet, tort reform is an issue that has not been on the President's agenda. We could hardly expect this since the Trial Lawyers Association is one of his biggest supporters. If we were to switch to the Canadian or British models we would simply substitute taxes for premiums and the net cost to working Americans would be higher. The real reasons for high costs in the US will still be ignored because liberals refuse to see them. Adoption of a socialized medicine model would therefore make even marginal sense only if the health care we would receive would be superior in quality, which, as will be seen below, it would not be.

When we review statistics examining outcomes measures for persons afflicted with various diseases, an interesting picture emerges. US mortality rates are lower for heart attacks, strokes and cancer than in Canada or Britain. Outcomes for patients in the US are generally better than their Canadian and European counterparts in a number of areas, including significantly better survivability in patients with most forms of cancer. The cover story of the February 2005 issue of The Spectator, a British magazine, was titled "Die in Britain, Survive in the US." The author, James Bartholomew, outlined the much better health care results obtained in the US compared to the UK. He notes: "The more one looks at the figures for survival, the more obvious it is that if you have a medical problem your chances are dramatically better in America than in Britain."

Canadian and British health care is delayed and less comprehensive. In 2006, about 201,000 people had problems obtaining non-emergency services in Canada. To understand that in terms of a similar effect on the US, we would have to multiply the number by ten to see that it would affect over two million Americans. Despite much touted access to primary care, about 4.1 million Canadians (equivalent in proportion to 41 million Americans) were without a primary doctor in 2008. An additional 607,000 (six million equivalent Americans) had problems getting in to see a specialist, and about 301,000 patients ( equal to 3 million Americans) experienced problems obtaining diagnostic procedures. About 1.1 million Canadians, or 3% of the population, had significant medical care access delays. In 1993, Canadian patients waited on average 9.3 weeks between the time they saw their family physician and the time they received needed treatment. By 2007, the wait time had almost doubled to 18.3 weeks. The median wait time in Canada is double the wait time that US physicians consider safe.  

British wait times are scarcely better. An article appearing in The Heartland Institute  in 2002 noted that with one person in 60 waiting for care, "Britons already in the queue for medical treatment will wait a total of one million years for care." One person in 60 in the US would mean a comparable figure of 5 million in line for care. A recent British publication reported that accident and emergency patients were being left in ambulances for up to five hours to prevent a negative impact on wait time statistics. In Britain, over six million people, or one tenth the population, have private health care coverage and that number is growing.

A liberal Canadian member of parliament felt the need to come to the US in order to obtain proper treatment for cancer and Canadians flock to the US and other countries for treatment due to prolonged wait times. "So much for the myth of government-run health care being compassionate and fair," said David Gratzer a Canadian doctor and senior fellow at the Manhattan Institute. "Canadians wait and wait and wait."  A Quebec physician, Dr. Jacques Chanoulli,  sued the Canadian government for not allowing patients to pay for better care. In 2004 a group of 10,000 breast cancer patients who had to wait an average of eight weeks for post-operative radiation treatments brought a class action suit against Quebec's hospitals.

Recently, actress Natasha Richardson died from head trauma due to a skiing accident after she had to be driven for over two hours to a trauma center. In the US she would have been airlifted and perhaps would have survived.  "Our system isn't set up for traumas and doesn't match what's available in other Canadian cities, let alone in the States," said Dr. Tarek Razek, director of trauma services for the McGill University Health Centre. In light of these facts and the outcomes statistics noted above, we must question the sanity of those in our government who want to adopt the this system of health care. 

Another perceived cause of our high cost of health care is the money paid to physicians. We are often told that US physicians earn too much money.  Perhaps we do, but "Canada care" or a British model NHS would not change that. Contrary to popular belief, Canadian physicians in primary care earn as much as or more than their American counterparts; $195,000 in Canada v. $150,000 in the US on average. In fact, US primary care physicians would likely see incomes increase under socialized medicine. One Canadian newspaper article noted that the average physician in British Columbia earned $300,000 in 2004. Another article cited family physicians earning over $700,000 yearly in Ontario. A British publication recently noted doctor earning up to 290,000 pounds, or $450,000. That same article reports the average family doctor's income is 118,000 pounds, or about $183,000. The mean income before taxes for US family physicians last year was $161,000 and the average physician income in the US was about $216,000.

Allegedly, there is significant inequity of access to health care in the US compared to Canada or the UK because over 40 million Americans are uninsured. While many people are uninsured for short periods of time, the number of chronically uninsured in reality is much lower.  Moreover, around 17% of "uninsured" Americans lived in households with incomes above $75,000 per year and could presumably afford insurance. Additionally, 14 million of those listed as uninsured are eligible for Medicare or Medicaid but find it easier just to go to the ER when they need to. The number of people in 2008 who were chronically uninsured was in fact between 9 and 13 million, or 3% of the US population.

There is also significant inequity of health care access in Canada and the United Kingdom, but this is usually overlooked by those who want government controlled health care. A study by the Frasier Institute noted that "the percentage of the population that was "effectively" uninsured for non-emergency, necessary medical services at any given time during 2007 was not significantly different between the two countries: 7.9 percent in the U.S. compared to 6 percent in Canada. A report presented by the Institute for Health Research showed a significant difference in health care delivery according to socioeconomic status in the United Kingdom.

So, in answering our initial questions:  The health-care in Canada and Great Britain is not better than ours in terms of quality of care and in fact does not approach equivalence with ours. These systems deliver less comprehensive care with significant delays, often with deadly results for these delays represented by much better outcomes for illness and age matched patients in the US. Additionally, these systems do not afford significantly lower cost for equivalent quality. Costs are rising at a faster rate than ours in Canada and as fast as ours in the U.K. There are hidden factors that seem to artificially report lower costs in these countries as well as easily addressed problems that raise costs in the US. Canada's health care system is poorly responsive, inefficient, underfunded, and in decline. It is not a system upon which to base our health care model. Is it any wonder that the father of socialized health care in Quebec, Claude Castonguay, is disowning it? He is now calling for the adoption of private health care! In 2005, the head of the Royal College of Surgeons called the NHS "unsustainable".  The UK is pushing forward with privatization of health care to prevent a complete collapse of the National Health Service. There seems to be little point in experimenting with a failed model that is looking to private health care as a solution to its own problems.

I believe the best solution for our country is one similar to that of Switzerland. This system is a government regulated free enterprise system that delivers high quality health care at a reasonable cost. Health insurance is mandatory but purchased privately, like auto insurance is here. Insurers may not refuse coverage to individuals and risk is spread out through a cooperative risk pool overseen by the government. There are no tax liabilities for purchasing individual insurance. Therefore, individuals own their coverage and do not lose it if they leave their jobs. People can change insurers twice yearly. Employers give their employees an allowance to help them purchase their coverage. Insurance for the economically disadvantaged is subsidized by the government based upon a needs test. The same system is in effect for all citizens and retired persons do not have a separate government funded system.  Doctors and hospitals are private as they are in the US. The system is simple, efficient and would be an easy transition given our current situation. Most importantly, it would not cost the federal government and the taxpayers much at all to initiate. Medicare and Medicaid could be scrapped for a tremendous savings almost immediately and that money could be diverted to repair the coming insolvency of Social Security.

Chairman Obama, Prime Minister Pelosi and Comrade Reed want socialized health care and all of their efforts will be directed toward that end, including misrepresenting the benefits of socialized health care systems. Mr. Obama's real goal is to increase the power of the federal government. We must try to prevent this move toward state control of health care. An intelligent examination and exposure of the flaws of socialized medicine is a good way to start. However, simply finding fault with other systems, preventing bad choices and pointing out deficiencies in our system must be only the beginning. Correcting the flaws in our system and structuring an efficient free market based health care model for the 21^st century is the way to finish.