On Wed, 9 Aug 2017 06:39:59 -0700 (PDT), me
Post by me
I am now in Canada for a couple of months. Last night i attended a small social gathering of summe residents at this place. One was a retired Canadian. He was formerly employed (at university) in the health care system. We talked. He told me heath care decisions are not solely decided by doctors. Doctors tend to think primarily in the interests of the individual patient, he said. His belief is that in 'socialized medical care' this attitude and motivation is not acceptable. He indicated it is not socially desirable to spend large sums on health care in the last years of life. Consequently, there exist in Canada "expert committees" to essentially do cost-benefit analyses to determine what government will pay for and what it will not pay for. Such 'expert committees' essentially ration spending on health care. It is one reason Canada spends less on health care than the US.
His wife also had worked as a professor in the university teaching health care before she retired. She has cancer and gets chemotherapy every three weeks for life. I'm guessing cost-benefit calculations did not apply to her. There seems to an unusually high incidence of cancer in this area. I have met people who received little of no treatment. They simply died. Cost-benefit calculations seem not to be evenly and equally applied.
"5 Myths About Canadian Health Care
by Aaron E. Carroll, M.D., M.S., April 16, 2012
How does the U.S. health care system stack up against
Canadas? Youve probably heard allegedly true horror
stories about the Canadian system like 340-day waits for
knee replacement surgery, for example.
To separate fact from fiction, Aaron E. Carroll, M.D., the
director of the Center for Health Policy and Professionalism
Research in Indianapolis, identified the top myths about the
two health care systems.
Myth #1: Canadians are flocking to the United States to get
How many times have you heard that Canadians, frustrated by
long wait times and rationing where they live, come to the
United States for medical care?
I dont deny that some well-off people might come to the
United States for medical care. If I needed a heart or lung
transplant, theres no place Id rather have it done. But
for the vast, vast majority of people, thats not happening.
The most comprehensive study Ive seen on this topic it
employed three different methodologies, all with solid
rationales behind them was published in the peer-reviewed
journal Health Affairs.
Source: Phantoms in the Snow: Canadians Use of Health Care
Services in the United States, Health Affairs, May 2002.
The authors of the study started by surveying 136 ambulatory
care facilities near the U.S.-Canada border in Michigan, New
York and Washington. It makes sense that Canadians crossing
the border for care would favor places close by, right? It
turns out, however, that about 80 percent of such facilities
saw, on average, fewer than one Canadian per month; about 40
percent had seen none in the preceding year.
Then, the researchers looked at how many Canadians were
discharged over a five-year period from acute-care hospitals
in the same three states. They found that more than 80
percent of these hospital visits were for emergency or
urgent care (that is, tourists who had to go to the
emergency room). Only about 20 percent of the visits were
for elective procedures or care.
Next, the authors of the study surveyed Americas 20 best
hospitals as identified by U.S. News & World Report on
the assumption that if Canadians were going to travel for
health care, they would be more likely to go to the
best-known and highest-quality facilities. Only one of the
11 hospitals that responded saw more than 60 Canadians in a
year. And, again, that included both emergencies and
Finally, the studys authors examined data from the 18,000
Canadians who participated in the National Population Health
Survey. In the previous year, 90 of those 18,000 Canadians
had received care in the United States; only 20 of them,
however, reported going to the United States expressively
for the purpose of obtaining care.
Myth #2: Doctors in Canada are flocking to the United States
Every time I talk about health care policy with physicians,
one inevitably tells me of the doctor he or she knows who
ran away from Canada to practice in the United States.
Evidently, theres a general perception that practicing
medicine in the United States is much more satisfying than
The Canadian Institute for Health Information has been
tracking doctors destinations since 1992. Since then, 60
percent to 70 percent of the physicians who emigrate have
headed south of the border. In the mid-1990s, the number of
Canadian doctors leaving for the United States spiked at
about 400 to 500 a year. But in recent years this number has
declined, with only 169 physicians leaving for the States in
2003, 138 in 2004 and 122 both in 2005 and 2006. These
numbers represent less than 0.5 percent of all doctors
working in Canada.
So when emigration spiked, 400 to 500 doctors were leaving
Canada for the United States. There are more than 800,000
physicians in the United States right now, so Im skeptical
that every doctor knows one of those émigrés.
In 2004, net emigration became net immigration. Let me say
that again. More doctors were moving into Canada than were
Myth #3: Canada rations health care; thats why hip
replacements and cataract surgeries happen faster in the
When people want to demonize Canadas health care system
and other single-payer systems, for that matter they
always end up going after rationing, and often hip
replacements in particular.
Take Republican Rep. Todd Akin of Missouri, for example. A
couple of years ago he took to the House floor to tell his
I just hit 62, and I was just reading that in Canada [if] I
got a bad hip I wouldnt be able to get that hip replacement
that [Rep. Dan Lungren] got, because Im too old! Im an old
geezer now and its not worth a government bureaucrat to pay
me to get my hip fixed.
This has been debunked so often, its tiring. The St. Louis
Post-Dispatch, for example, concluded: At least 63 percent
of hip replacements performed in Canada last year  ...
were on patients age 65 or older. And more than 1,500 of
those, it turned out, were on patients over 85.
The bottom line: Canada doesnt deny hip replacements to
But theres more.
Know who gets most of the hip replacements in the United
States? Older people.
Know who pays for care for older people in the United
Know what Medicare is? A single-payer system.
Myth #4: Canada has long wait times because it has a
The wait times that Canada might experience are not caused
by its being a single-payer system.
Wait times arent like cancer. We know what causes wait
times; we know how to fix them. Spend more money.
Our single-payer system, which is called Medicare (see
above), manages not to have the wait times issue that
Canadas does. There must, therefore, be some other reason
for the wait times. There is, of course.
In 1966, Canada implemented a single-payer health care
system, which is also known as Medicare. Since then, as a
country, Canadians have made a conscious decision to hold
down costs. One of the ways they do that is by limiting
supply, mostly for elective things, which can create wait
times. Their outcomes are otherwise comparable to ours.
Please understand, the wait times could be overcome.
Canadians could spend more. They dont want to. We can
choose to dislike wait times in principle, but they are a
byproduct of Canadas choice to be fiscally conservative.
Yes, they chose this. In a rational world, those who are
concerned about health care costs and what they mean to the
economy might respect that course of action. But instead,
they attack the system.
Myth #5: Canada rations health care; the United States
This ones a little bit tricky. The truth is, Canada may
ration by making people wait for some things, but here in
the United States we also ration by cost.
An 11-country survey carried out in 2010 by the Commonwealth
Fund, a Washington-based health policy foundation, found
that adults in the United States are by far the most likely
to go without care because of cost. In fact, 42 percent of
the Americans surveyed did not express confidence that they
would be able to afford health care if seriously ill.
Source: How Health Insurance Design Affects Access to Care
and Costs, by Income, in Eleven Countries, Health Affairs,
Further, about a third of the Americans surveyed reported
that, in the preceding year, they didnt go to the doctor
when sick, didnt get recommended care when needed, didnt
fill a prescription or skipped doses of medications because
Finally, about one in five of the Americans surveyed had
struggled to pay or were unable to pay their medical bills
in the preceding year. That was more than twice the
percentage found in any of the other 10 countries.
And remember: Were spending way more on health care than
any other country, and for all that money were getting at
best middling results.
So feel free to have a discussion about the relative merits
of the U.S. and Canadian health care systems. Just stick to
Aaron E. Carroll frequently blogs about this topic for The
Incidental Economist and is the coauthor of Dont Swallow
Your Gum: Myths, Half-Truths, and Outright Lies About Your
Body and Health."