U.S. Health Care Compared to Others

In one of my columns I called for a governmental single-payer system of health insurance. Although health insurance was the main topic of my column, I remarked that health care systems in other countries, such as Canada, were not inferior to ours. One reader wrote that in Canada, there is a lack of choice: “people are assigned a doctor, not necessarily the one they want.” He also mentioned that Canadians have long waits for surgical and other procedures and that doctors “are leaving Canada in droves” to practice in the United States. He argued that, “We might not have the most efficient system, but, without a doubt we have the best.”

Lets start with the last point first. In 2000, the World Health Organization (WHO) ranked the United States 37th in the World in providing health care; hardly the best! It found that France provided the best overall health care followed among major countries by Italy, Spain, Oman, Austria, and Japan. It noted that the United States had by far the most expensive health care system in the world. It noted that the U.S. is “the only country in the developed world, except for South Africa, that does not provide health care for all of its citizens.”

The WHO found that the two countries with the highest percentage of people who were either very satisfied or fairly satisfied with their country’s health care system were Denmark (91%) and Finland (81%). The U.S. was comparatively low with only 40 percent who were satisfied with their health care system.

In a 2004 survey entitled Primary Care and Health System Performance: Adults’ Experiences in Five Countries, comparing health care in Australia, New Zealand, Canada, The United Kingdom, and the United States, the journal Health Affairs found that “the United States performs poorly on most care dimensions in the study.” The survey found that “Based on a question also asked in 1998 and 2001, the United States stands out as the most negative in overall public views and the United Kingdom as the most positive, repeating a pattern observed across the six years.”

Under its system, informally called “Medicare,” patients in Canada are free to choose their own doctors, hospital, etc. Although some Canadian doctors may have left Canada in the past for more lucrative practices in the United States, new statistics compiled by the Canadian Institute for Health Information (CIHI) show that now, more physicians have returned to Canada than have moved abroad. In a joint survey of health, 2002-2003, by the United States Centers for Disease Control and Prevention (CDC) and the Canadian Health Analysis and Measurement Group (HAMG) it was found that more Canadians (85%) than Americans (80%) reported having a regular medical doctor. The 2004 survey by Health Affairs found that the United States was notably lower than the other four countries in patients having either a regular doctor or place of care such as a clinic, health center, or group practice.

Most Canadians are highly satisfied with their health care system. While waiting periods for certain procedures are long in Canada, Americans also have some long waiting periods. The Health survey found that although Americans generally have shorter waits for elective surgery than Canadians, Germans have shorter waits than Americans. Overall, more Americans than Canadians reported that they experienced an unmet health care need in the previous year (13% vs. 11%). In Canada, emergencies are promptly treated and nobody is turned away from a hospital because he is uninsured.

Even though the government of Canada covers everybody with health care, the United States, with its limited governmental involvement in health care under Medicare, Medicaid, and other programs, spent a higher percentage of its budget on health care than Canada. While Canada’s health system is cheaper than ours, it compares well with ours. Life expectancy in 2002 was about 2½ years higher in Canada than in the United States. Infant child death rates are markedly higher in the United States than in Canada. So are the death rates for adults. Although Canada has a higher rate of smokers, the death rate for all cancers was significantly higher per capita in the U.S. than in Canada.

The people who are suffering the most from lack of insurance in America are not the poorest citizens. Poor people have Medicaid. The ones who suffer are working people who work for small businesses or for themselves. They are not poor enough for Medicaid or rich enough for the rapidly rising costs of health insurance. They either die prematurely, forego necessary medical treatment, or get wiped-out by exorbitant medical bills. Are these people unimportant? Are their children unimportant? Must we abandon 45 million fellow Americas as an obscene sacrifice to the bloated god of profit? Let us not forget that there is a human tragedy happening to uninsured people in the United States of America.