But It’s Not Much Better Down South

I haven’t seen Sicko and probably won’t for at least a week or so. As always, Michael Moore continues his Canada fetish and he romanticizes Canada’s health system like crazy.

BUT, I think it’s important to remember that there isn’t a whole lot of difference between the U.S. and Canadian health care systems. Of all health care systems in the G8, the U.S. and Canada are probably the two most similar. Both are government-controlled systems in which most operators remain nominally private and where many people have problems with access to care. Both systems allow for profits in theory but often force hospitals and doctors to operate at a loss. Both systems provide de facto universal coverage. Canada, in theory, requires everyone to sign up for provincial health insurance although, in fact, not everyone does. The U.S. subsidizes insurance in a million ways but then just forces hospitals and doctors to pick up the bills for anyone who doesn’t have it. As a legal matter, it is probably easier for a Canadian hospital to refuse treatment to someone without insurance. The U.S. provides a mostly-public patchwork of programs and makes it practical for employers to buy insurance on the private market. Neither country has a truly functioning market for individuals who want to buy private insurance.

The U.S. medical system is 53 percent government-run, Canada’s 63 percent. The Canadian system costs less (largely because it pays lower wages to providers) and provides better preventative care. The U.S. system costs more and does a better job with end-of-life care and patient comfort. It also has a lot more waste on things that either don’t work (most back surgery) or aren’t necessary (just-to-be-sure MRIs). Americans planning to pay out-of-pocket often go to Canada to get surgery. Canadians sick of waiting lists often head down south to get surgery.

Because there are three major government payers in the U.S. system and dozens of other minor programs, the direct “burden of government” on medicine is probably greater in the U.S. than in Canada because it’s a lot harder for hospitals and doctors to get paid. Both the U.S. and Canada set most medical prices via government fiat although, by virtue of its design, the Canadian provincial health insurance plans tend to exert somewhat more pricing power than their U.S. counterparts.

The U.S. has waiting lists and some Canadians have trouble paying for medical care they need. In the example cited in Ivan’s post, a Canadian ends up on a drug rehab waiting list…well, we have those down here too. In the U.S. access problems fall disproportionately on the childless poor and, to a lesser extent, the elderly poor on Medicaid. In Canada, they’re more evenly distributed. In both places, rationing of various kinds produces them at levels that are far too high.

Both systems have an enormous state role. Both need overhauls. Were I Canadian, I would not want to impose the American medical system. Were I American, I would not want the Canadian system imposed on the U.S. We need a different option altogether.