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The California Nurses Association cheering Michael Moore at a single-payer rally in Sacramento in June 2007. (AP photo)

The press needs to tell us more about Canada’s single-payer health-care system

COMMENTARY | September 21, 2007

International data have long been easily available; they show Americans spending more but slipping in rankings for life expectancy and other key health issues. But few news organizations pay attention—not even to our nearest neighbor—and commentators deluge the public with false, misleading punditry. (Second of three articles)

By Morton Mintz

Substantial mainstream reporting on single-payer health insurance should have been triggered—or so one might think—by a succession of studies over the years that establish that Canada's health-care system saves or improves large numbers of lives while not wasting money on administrative expenses and fat executive-pay packages. Almost without fail, Canada gets higher ratings than the U.S.

In 2000, for example, the World Health Organization examined and rated the health systems of 191 nations. The United States ranked 37th. Canada scored significantly better although it was not outstanding—it placed 30th. But this study was only one of many that had Canada topping the U.S. (Click here and go to pages 152 to 155 in a PDF file for the rankings of all 191 countries.)

Between November 2002 and March 2003, the official statistics agencies of the United States and Canada did their first-ever joint survey of the health status, rates of illness, behavioral risk factors, use of health care, and access to health care. The survey included 3,505 Canadians and 5,183 U.S. residents. The results were analyzed by two associate professors of medicine at Harvard Medical School.

"A single-payer national health insurance system would avoid thousands of needless deaths and hundreds of thousands of medical bankruptcies each year," Drs. Steffie Woolhandler and  David Himmelstein concluded in the July 2006 issue of the American Journal of Public Health. In addition, U.S. residents turned out to be less healthy than Canadians, with higher rates of nearly every serious chronic disease examined in the survey, including diabetes, arthritis, and chronic lung disease. And more than seven times as many U.S. residents as Canadians reported that cost kept them from getting needed care.

Some other examples:

  • In April 2007, the Canadian online medical journal Open Medicine examined the results of 38 major studies that compared health outcomes of patients in Canada and the United States with "diverse problems...including cancer, coronary artery disease, chronic medical illnesses and surgical procedures." The key finding: "Available studies suggest that health outcomes may be superior in patients cared for in Canada versus the United States, but differences are not consistent." Yet Canada spends only about 10 percent of its gross domestic product on health care while the U.S. spends approximately 15 percent of its GDP, or 50 percent more, the journal noted. And in 2003 Canadians were spending only 53 percent as much per capita for health care as were Americans: US$3,003 per Canadian v. US$5,635 per American.
  • In May, the Commonwealth Fund compared the quality of care, access to it, and other key issues in six countries: the U.S, Australia, Canada, Germany, New Zealand and the United Kingdom on such key issues. The U.S. ranked last.
  • In July, New York Times columnist Paul Krugman pointed out that the U.S. health care system does worse than others that cost far less, including Britain's, "which spends only about 40 percent as much per person as we do."

And in August, Associated Press Writer Stephen Ohlemacher wrote:

Americans are living longer than ever, but not as long as people in 41 other countries.

For decades, the United States has been slipping in international rankings of life expectancy, as other countries improve health care, nutrition and lifestyles. Countries that surpass the U.S. include Japan and most of Europe, as well as Jordan, Guam and the Cayman Islands.

"Something's wrong here when one of the richest countries in the world, the one that spends the most on health care, is not able to keep up with other countries," said Dr. Christopher Murray, head of the Institute for Health Metrics and Evaluation at the University of Washington.

A baby born in the United States in 2004 will live an average of 77.9 years. That life expectancy ranks 42nd, down from 11th two decades earlier, according to international numbers provided by the Census Bureau and domestic numbers from the National Center for Health Statistics.

Also in August, a thoroughly researched lead editorial in the Times called it a "delusion that we have 'the best health care system in the world,' as President Bush sees it, or provide the 'best medical care in the world,' as Rudolph Giuliani declared.”

Single-payer is government-financed, not government-run, and it is therefore not "socialized," as are some other universal-care systems. Private physicians, private hospitals, and other private caregivers are paid by the government of Canada, just as their U.S. counterparts are paid under Medicare.

These are simple, instantly-available facts. Yet Americans are deluged by uninformed and false and misleading commentary, ideologically-driven denunciations of "socialized medicine," and bad-mouthing of Michael Moore and "Sicko." Here are some examples from a compilation by Caroline Kao in the August "Extra! Update":

Single-payer healthcare...is frequently described as 'government-run' or 'socialized' health care or medicine (e.g., US Today, 6/13/07; CNN, 6/25/07; O'Reilly Factor, 6/27/07...

On CNBC (Kudlow & Co., 6/20/07), right-wing filmmaker Stuart Browning mourned the loss of personal choice, saying Moore and HR 676 (a U.S. single-payer bill] supporters "advocate systems in which we would not be able to spend our own money on our own bodies."

Fox's Morton Kondracke (Beltway Boys, 6/24/07) warned of a slippery slope from single-payer care to a socialist dictatorship, saying that "Moore basically wants socialized everything..."

The same network's Sean Hannity called Michael Moore "'a pathetic propagandist'" who is "'not even any good at it' (Hannity and Colmes, 6-19/07).

On Sept. 14, during an hour-long report on "America's health-care system," ABC's 20/20 co-host John Stossel, MediaMatters reported, “interviewed five advocates of free-market approaches to health care but only one advocate of increased government-mandated health coverage. The five free-market advocates were interviewed on air for a total of 6 minutes, 24 seconds, while the lone advocate of a public health system, filmmaker Michael Moore, was interviewed on air for a total of 1:40.”

A few days earlier, New York Times op-ed columnist David Brooks wrote three sentences indicating that he shares the dedication of President Bush to the preservation of private insurers no matter what.The first sentence: "Some liberals, believing that government should step in as employers withdraw, support a European-style, single-payer health care system."

Europe has several different systems of universal health care; Canada has long had single-payer in its purest form. Yet Brooks somehow found it necessary to cross the Atlantic, in a manner of speaking. Of course, associating single-payer with Europe, not to mention liberals, is much more likely to turn off readers on it than would be associating it with our next-door neighbor.

Brooks’s second sentence: "That would be fine if we were Europeans." Leading readers to imagine themselves as Europeans is confusing and vague (who are these Europeans? Belgians? Dutch? French? Germans? Italians?) and consequently also a more likely turn-off than would be leading readers to imagine themselves as our familiar northern neighbors.

And the third sentence: "But Americans, who are more individualistic and pluralistic, will not likely embrace a system that forces them to defer to the central government when it comes to making fundamental health care choices."

Really? Since 1965, Medicare has been, as Brooks would have it, forcing all elderly Americans "to defer to the central government." In the ensuing 42 years, has anyone noticed signs of a rebellion among the "more individualistic and pluralistic" Americans who happen to be Golden-Oldies?

Most importantly: Single-payer is, at bottom, Medicare for all. What evidence would Brooks offer that Medicare for all would not be embraced by, say, the 47 million Americans who have no health insurance? Or by the 40 of 100 Americans found in a Consumer Reports survey to be inadequately insured? Or by the 44 out of 100 Americans, who, in a Wall Street Journal/NBC News poll, identified "health care costs" as their top economic worry?

The lack of mainstream in-depth coverage of universal health-care systems--established long ago by every industrialized nation except our own—has given a pass to sloppy, biased reporting and deceptive, misleading punditry. The impoverishment of our politics and governance—and health-care and pocketbooks—were natural consequences.

Next: Health care is only one of numerous important areas where the press has consistent tunnel vision.

It's not so simple
Posted by Johngeddes Geddes - Ottawa Bureau Chief, Maclean's Nieman '03
09/27/2007, 01:09 PM

As a Canadian, I barely recognize our health system in the descriptions that pop up in the U.S. media. Right-wingers make crazy claims about its shortcomings; left-wingers imagine a single-payer paradise.

Obviously, both side are drawing caricatures.

For the record, I much prefer Canada’s publicly insured system to the plainly unacceptable U.S. private-insurance mess. But there’s a lot more to report on here than broad conclusions about which way is ultimately better.

Like Morton, I find the Commonwealth Fund’s documents useful, especially “Health System Performance in Selected Nations: A Chartpack”—130 pages of clearly presented statistics comparing Australia, Canada, Germany, New Zealand, Britain, and the U.S.

When it comes to the Canada/U.S. contrast, it's no surprise that Canada's system looks much fairer. Money doesn't matter nearly as much here. A statistic that jumps out: in a 2005 survey, 34 per cent of "sicker" American adults reported instances when they had a medical problem but did not visit a doctor, compared to only 7 per cent of Canadians.

Still, our Canadian insistence on equal access has undeniably led to sluggishness of the sort that plagues bureaucratic systems everywhere. In Canada, 36 per cent of sicker adults reported having to wait six days or longer for a necessary medical appointment, compared to just 23 per cent of Americans. Worse, 57 per cent of Canadians who needed to see a specialist had to wait more than four weeks, compared to 23 per cent of Americans.

Those findings might seem to confirm an image of a U.S. system shaped by market forces, and thus more nimble and responsive than Canada's publicly funded care.

But consider this: just 30 per cent of U.S. primary care doctors report that there’s any financial incentive in their practice for improving the quality of care to their patients. In Canada, 41 per cent of physicians say they have the potential to get more money if they improve care.

Doesn’t that fly in the face of what we might assume to be the inherent characteristics of private and public systems?

There are plenty many more surprises in the numbers. So let's not pretend this is a simple story. Sure, Canada’s system is fairer. Yes, the U.S. model is often faster. Beyond such valid generalizations, beloved by those arguing for one way or the other, there’s a lot of nuanced journalism to do.

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