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this all makes sense....but i think it comes down to a question of
utilitarianism. all my friends from canada say that universal health care
is great because everyone goes for annual checkups, because you can and it's
covered. but the richest people, for anything slightly more complicated
(bypasses, surgeries, etc) come down to the US, where their money buys them
improved technology and faster service. waiting lists for everything are
apparently really long in canada. this is what i hear, at least.
so, it seems there's this interesting dichotomy - they get nice, regular,
for the masses health care, but for the really cutting edge stuff or just
lesser waiting lists, you'd still want to be both 1) rich, and 2) in the
states. it's essentially a battle of good for the overall masses vs.
available supergoodness for the individual in times of need.
i wish we could have both.
lisa
On 9/21/06, Robert Felty wrote:
>
> Here is an interesting article from Yes magazine comparing health
> care statistics of different countries. The U.S. ranks much lower
> than one might think, and Canada's stats have gotten much better
> since 1970, when they implemented nationalized health care.
> http://www.yesmagazine.org/article.asp?ID=3D1503
>
> Text pasted below
> __________________________________
> Has Canada Got the Cure?
> by Holly Dressel
>
>
> Publicly funded health care has its problems, as any Canadian or
> Briton knows. But like democracy, it's the best answer we've come
> up with so far.
>
> US Canada Health CareShould the United States implement a more
> inclusive, publicly funded health care system? That's a big debate
> throughout the country. But even as it rages, most Americans are
> unaware that the United States is the only country in the developed
> world that doesn't already have a fundamentally public--that is, tax-
> supported--health care system.
>
> That means that the United States has been the unwitting control
> subject in a 30-year, worldwide experiment comparing the merits of
> private versus public health care funding. For the people living in
> the United States, the results of this experiment with privately
> funded health care have been grim. The United States now has the most
> expensive health care system on earth and, despite remarkable
> technology, the general health of the U.S. population is lower than
> in most industrialized countries. Worse, Americans' mortality rates--
> both general and infant--are shockingly high.
>
> Different paths
>
> Beginning in the 1930s, both the Americans and the Canadians tried to
> alleviate health care gaps by increasing use of employment-based
> insurance plans. Both countries encouraged nonprofit private
> insurance plans like Blue Cross, as well as for-profit insurance
> plans. The difference between the United States and Canada is that
> Americans are still doing this, ignoring decades of international
> statistics that show that this type of funding inevitably leads to
> poorer public health.
>
> Meanwhile, according to author Terry Boychuk, the rest of the
> industrialized world, including many developing countries like
> Mexico, Korea, and India, viscerally understood that "private
> insurance would [never be able to] cover all necessary hospital
> procedures and services; and that even minimal protection [is] beyond
> the reach of the poor, the working poor, and those with the most
> serious health problems." 1 Today, over half the family bankruptcies
> filed every year in the United States are directly related to medical
> expenses, and a recent study shows that 75 percent of those are filed
> by people with health insurance.2
>
> The United States spends far more per capita on health care than any
> comparable country. In fact, the gap is so enormous that a recent
> University of California, San Francisco, study estimates that the
> United States would save over $161 billion every year in paperwork
> alone if it switched to a singlepayer system like Canada's.3 These
> billions of dollars are not abstract amounts deducted from government
> budgets; they come directly out of the pockets of people who are sick.
>
> The year 2000 marked the beginning of a crucial period, when
> international trade rules, economic theory, and political action had
> begun to fully reflect the belief in the superiority of private, as
> opposed to public, management, especially in the United States. By
> that year the U.S. health care system had undergone what has been
> called "the health management organization revolution." U.S.
> government figures show that medical care costs have spiked since
> 2000, with total spending on prescriptions nearly doubling. 4
>
> Cutting costs, cutting care There are two criteria used to judge a
> country's health care system: the overall success of creating and
> sustaining health in the population, and the ability to control costs
> while doing so. One recent study published in the Canadian Medical
> Association Journal compares mortality rates in private forprofit and
> nonprofit hospitals in the United States. Research on 38 million
> adult patients in 26,000 U.S. hospitals revealed that death rates in
> for-profit hospitals are signifi cantly higher than in nonprofit
> hospitals: for-profit patients have a 2 percent higher chance of
> dying in the hospital or within 30 days of discharge. The increased
> death rates were clearly linked to "the corners that for-profit
> hospitals must cut in order to achieve a profit margin for investors,
> as well as to pay high salaries for administrators."5
>
> "To ease cost pressures, administrators tend to hire less highly
> skilled personnel, including doctors, nurses, and pharmacists ,"
> wrote P. J. Devereaux, a cardiologist at McMaster University and the
> lead researcher. "The U.S. statistics clearly show that when the
> need for profits drives hospital decisionmaking, more patients die."
>
> The value of care for all
>
> Historically, one of the cruelest aspects of unequal income
> distribution is that poor people not only experience material want
> all their lives, they also suffer more illness and die younger. But
> in Canada there is no association between income inequality and
> mortality rates none whatsoever.
>
> In a massive study undertaken by Statistics Canada in the early
> 1990s, income and mortality census data were analyzed from all
> Canadian provinces and all U.S. states, as well as 53 Canadian and
> 282 American metropolitan areas.6 The study concluded that "the
> relationship between income inequality and mortality is not
> universal, but instead depends on social and political
> characteristics specific to place." In other words, government
> health policies have an effect.
>
> "Income inequality is strongly associated with mortality in the
> United States and in North America as a whole," the study found,
> "but there is no relation within Canada at either the province or
> metropolitan area level -- between income inequality and mortality."
>
> The same study revealed that among the poorest people in the United
> States, even a one percent increase inincome resulted in a mortality
> decline of nearly 22 out of 100,000.
>
> What makes this study so interesting is that Canada used to have
> statistics that mirrored those in the United States. In 1970, U.S.
> and Canadian mortality rates calculated along income lines were
> virtually identical. But 1970 also marked the introduction of
> Medicare in Canada -- universal, singlepayer coverage. The simple
> explanation for how Canadians have all become equally healthy,
> regardless of income, most likely lies in the fact that they have a
> publicly funded, single-payer health system and the control group,
> the United States, does not.
>
> Infant mortality
>
> Infant mortality rates, which refl ect the health of the mother and
> her access to prenatal and postnatal care, are considered one of the
> most reliable measures of the general health of a population. Today,
> U.S. government statistics rank Canada's infant mortality rate of 4.7
> per thousand 23rd out of 225 countries, in the company of the
> Netherlands, Luxembourg, Australia, and Denmark. The U.S. is 43rd--in
> the company of Croatia and Lithuania, below Taiwan and Cuba.
>
> All the countries surrounding Canada or above it in the rankings have
> tax-supported health care systems. The countries surrounding the
> United States and below have mixed systems or are, in general,
> extremely poor in comparison to the United States and the other G8
> industrial powerhouses.
>
> There are no major industrialized countries near the United States in
> the rankings. The closest is Italy, at 5.83 infants dying per
> thousand, but it is still ranked five places higher.7
>
> In the United States, infant mortality rates are 7.1 per 1,000, the
> highest in the industrialized world -- much higher than some of the
> poorer states in India, for example, which have public health systems
> in place, at least for mothers and infants. Among the inner-city poor
> in the United States, more than 8 percent of mothers receive no
> prenatal care at all before giving birth.
>
> Overall U.S. mortality
>
> We would have expected to see steady decreases in deaths per thousand
> in the mid-twentieth century, because so many new drugs and
> procedures were becoming available. But neither the Canadian nor the
> American mortality rate declined much; in fact, Canada's leveled off
> for an entire decade, throughout the 1960s. This was a period in
> which private care was increasing in Canadian hospitals, and the
> steady mortality rates reflect the fact that most people simply
> couldn't afford the new therapies that were being offered. However,
> beginning in 1971, the same year that Canada's Medicare was fully
> applied, official statistics show that death rates suddenly
> plummeted, maintaining a steep decline to their present rate.
>
> In the United States, during the same period, overall mortality rates
> also dropped, reflecting medical advances. But they did not drop
> nearly so precipitously as those in Canada after 1971. But given that
> the United States is the richest country on earth, today's overall
> mortality rates are shockingly high, at 8.4 per thousand, compared to
> Canada's 6.5.
>
> Rich and poor
>
> It has become increasingly apparent, as data accumulate, that the
> overall improvement in health in a society with tax-supported health
> care translates to better health even for the rich, the group assumed
> to be the main beneficiaries of the American-style private system. If
> we look just at the 5.7 deaths per thousand among presumably richer,
> white babies in the United States, Canada still does better at 4.7,
> even though the Canadian figure includes all ethnic groups and all
> income levels. Perhaps a one-per-thousand difference doesn't sound
> like much. But when measuring mortality, it's huge. If the U.S.
> infant mortality rate were the same as Canada's, almost 15,000 more
> babies would survive in the United States every year.
>
> If we consider the statistics for the poor, which in the United
> States have been classified by race, we find that in 2001, infants
> born of black mothers were dying at a rate of 14.2 per thousand.
> That's a Third World figure, comparable to Russia's.8
>
> But now that the United States has begun to do studies based on
> income levels instead of race, these "cultural" and genetic
> explanations are turning out to be baseless. Infant mortality is
> highest among the poor, regardless of race.
>
> Vive la diff=E9rence! Genetically, Canadians and Americans are quite
> similar. Our health habits, too, are very much alike -- people in
> both countries eat too much and exercise too little. And, like the
> United States, there is plenty of inequality in Canada, too. In terms
> of health care, that inequality falls primarily on Canadians in
> isolated communities, particularly Native groups, who have poorer
> access to medical care and are exposed to greater environmental
> contamination. The only major difference between the two countries
> that could account for the remarkable disparity in their infant and
> adult mortality rates, as well as the amount they spend on health
> care, is how they manage their health care systems.
>
> The facts are clear: Before 1971, when both countries had similar,
> largely privately funded health care systems, overall survival and
> mortality rates were almost identical. The divergence appeared with
> the introduction of the single-payer health system in Canada.
>
> The solid statistics amassed since the 1970s point to only one
> conclusion: like it or not, believe it makes sense or not, publicly
> funded, universally available health care is simply the most powerful
> contributing factor to the overall health of the people who live in
> any country. And in the United States, we have got the bodies to
> prove it.
>
> Holly Dressel was born south of Chicago and lives in Montreal,
> Quebec. She is a writer/researcher and the best-selling co-author,
> with David Suzuki, of Good News for a Change and other works.
>
> This article was adapted from Holly Dressel's book God Save the
> Queen God Save Us All: An Examination of Canadian Hospital Care via
> the Life and Death of Montreal's Queen Elizabeth Hospital, to be
> published in 2007 by McGill/Queen's Press.
>
> 1Terry Boychuk. The Making and Meaning of Hospital Policy in the
> United States and Canada. University of Michigan Press, Ann Arbor: 1999.
> 2David U. Himmelstein, et al. Health Affairs, Jan. June 2005, http://
> content.healthaffairs.org/cgi/reprint/hlthaff.w5.63v1
> 3Professor James Kahn, UCSF, quoted in Harper's Magazine,
> "Harper's List," Feb. 2006.
> 4National Health Expenditure Data, www.cms.hhs.gov/
> NationalHealthExpendData/downloads/tables.pdf.
> 5Devereaux, Dr. P.J., et al. "A Systematic Review and Meta-Analysis
> of Studies Comparing Mortality between Private For-Profit and Private
> Not-For-Profit Hospitals," Canadian Medical Association Journal,
> May, 2002.
> 6Nancy A. Ross et al. "Relation between income inequality and
> mortality in Canada and in the United States: cross sectional
> assessment using census data and vital statistics," Statistics
> Canada, reprinted in Health Geography, GEOG-303, ed. Nancy Ross,
> McGill University, 2005, pp. 109-117.
> 7CIA World Fact Book. www.cia.gov/cia/publications/factbook/rankorder/
> 2091rank.html
> 8See, among many studies blaming race, Child Health USA 2003, Health
> Status Infants; HRSA, with graphs such as "Breastfeeding Rates
> by Race/Ethnicity, 2001"; "Very Low Birth Weight Among Infants, by
> Race/Ethnicity 1985-2001"; http://www.mchb.hrsa.gov/chusa03.
> --
> Robert Felty http://www-personal.umich.edu/~robfelty
>
> I took a course in speed reading and was able to read War and Peace in
> twenty minutes. It's about Russia.
> -- Woody Allen
>
>
>
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this all makes sense....but i think it comes down to a question of
utilitarianism. all my friends from canada say that universal
health care is great because everyone goes for annual checkups, because
you can and it's covered. but the richest people, for anything
slightly more complicated (bypasses, surgeries, etc) come down to the
US, where their money buys them improved technology and faster
service. waiting lists for everything are apparently really long
in canada. this is what i hear, at least.
so, it seems there's this interesting dichotomy - they get nice,
regular, for the masses health care, but for the really cutting edge
stuff or just lesser waiting lists, you'd still want to be both 1)
rich, and 2) in the states. it's essentially a battle of good for
the overall masses vs. available supergoodness for the individual in
times of need.
i wish we could have both.
lisa On 9/21/06, Robert Felty < robfelty Æ umich.edu > wrote:
Here is an interesting article from Yes magazine comparing health care
statistics of different countries. The U.S. ranks much lower than one might
think, and Canada's stats have gotten much better since 1970, when they
implemented nationalized health care.
http://www .yesmagazine.org/article.asp?ID=3D1503 Text pasted below
__________________________________ Has Canada Got the Cure? by Holly Dressel
Publicly funded health care has its problems, as any Canadian or Briton
knows. But like democracy, it's the best answer we've come up with so far. US
Canada Health CareShould the United States implement a more
inclusive, publicly funded health care system? That's a big debate throughout
the country. But even as it rages, most Americans are unaware that the United
States is the only country in the developed world that doesn 't already have a
fundamentally public--that is, tax-
supported--health care system. That means that the United States has been
the unwitting control subject in a 30-year, worldwide experiment comparing the
merits of private versus public health care funding. For the people living in
the United States, the results of this experiment with privately funded
health care have been grim. The United States now has the most expensive
health care system on earth and, despite remarkable technology, the general
health of the
U.S. population is lower than in most industrialized countries. Worse,
Americans ' mortality rates-- both general and infant--are shockingly high .
Different paths Beginning in the 1930s, both the Americans and the Canadians
tried to
alleviate health care gaps by increasing use of employment-based insurance
plans. Both countries encouraged nonprofit private insurance plans like Blue
Cross, as well as for-profit insurance plans. The difference between the
United States and Canada is that
Americans are still doing this, ignoring decades of international statistics
that show that this type of funding inevitably leads to poorer public health.
Meanwhile, according to author Terry Boychuk, the rest of the
industrialized world, including many developing countries like Mexico , Korea,
and India, viscerally understood that "private insurance would [never be able
to] cover all necessary hospital procedures and services ; and that even
minimal protection [is] beyond
the reach of the poor, the working poor, and those with the most serious
health problems." 1 Today, over half the family bankruptcies filed every year
in the United States are directly related to medical
expenses, and a recent study shows that 75 percent of those are filed by
people with health insurance.2 The United States spends far more per capita
on health care than any comparable country. In fact, the gap is so enormous
that a recent
University of California, San Francisco, study estimates that the United
States would save over $161 billion every year in paperwork alone if it
switched to a singlepayer system like Canada's.3 These billions of dollars are
not abstract amounts deducted from government
budgets; they come directly out of the pockets of people who are sick. The
year 2000 marked the beginning of a crucial period, when international trade
rules, economic theory, and political action had begun to fully reflect the
belief in the superiority of private, as
opposed to public, management, especially in the United States. By that year
the U.S. health care system had undergone what has been called "the health
management organization revolution." U.S. government figures show that medical
care costs have spiked since
2000, with total spending on prescriptions nearly doubling. 4 Cutting costs,
cutting care There are two criteria used to judge a country 's health care
system: the overall success of creating and sustaining health in the
population, and the ability to control costs
while doing so. One recent study published in the Canadian Medical Association
Journal compares mortality rates in private forprofit and nonprofit hospitals
in the United States. Research on 38 million adult patients in 26,000
U.S. hospitals revealed that death rates in for-profit hospitals are signifi
cantly higher than in nonprofit hospitals: for-profit patients have a 2
percent higher chance of dying in the hospital or within 30 days of discharge.
The increased
death rates were clearly linked to "the corners that for-profit hospitals must
cut in order to achieve a profit margin for investors, as well as to pay high
salaries for administrators."5 "To ease cost pressures, administrators tend
to hire less highly
skilled personnel, including doctors, nurses, and pharmacists ," wrote P. J.
Devereaux, a cardiologist at McMaster University and the lead researcher. "The
U.S. statistics clearly show that when the need for profits drives hospital
decisionmaking, more patients die."
The value of care for all Historically, one of the cruelest aspects of
unequal income distribution is that poor people not only experience material
want all their lives, they also suffer more illness and die younger. But
in Canada there is no association between income inequality and mortality
rates none whatsoever. In a massive study undertaken by Statistics Canada in
the early 1990s, income and mortality census data were analyzed from all
Canadian provinces and all U.S. states, as well as 53 Canadian and 2 American
metropolitan areas.6 The study concluded that "the relationship between income
inequality and mortality is not universal, but instead depends on social and
political
characteristics specific to place." In other words, government health
policies have an effect. "Income inequality is strongly associated with
mortality in the United States and in North America as a whole," the study
found,
"but there is no relation within Canada at either the province or metropolitan
area level -- between income inequality and mortality." The same study
revealed that among the poorest people in the United States , even a one
percent increase inincome resulted in a mortality
decline of nearly 22 out of 100,000. What makes this study so interesting is
that Canada used to have statistics that mirrored those in the United States.
In 1970, U.S. and Canadian mortality rates calculated along income lines were
virtually identical. But 1970 also marked the introduction of Medicare in
Canada -- universal, singlepayer coverage. The simple explanation for how
Canadians have all become equally healthy, regardless of income, most likely
lies in the fact that they have a
publicly funded, single-payer health system and the control group, the United
States, does not. Infant mortality Infant mortality rates, which refl ect
the health of the mother and her access to prenatal and postnatal care, are
considered one of the
most reliable measures of the general health of a population. Today, U.S.
government statistics rank Canada's infant mortality rate of 4.7 per thousand
23rd out of 225 countries, in the company of the Netherlands , Luxembourg,
Australia, and Denmark. The
U.S. is 43rd--in the company of Croatia and Lithuania, below Taiwan and Cuba .
All the countries surrounding Canada or above it in the rankings have
tax-supported health care systems. The countries surrounding the
United States and below have mixed systems or are, in general, extremely poor
in comparison to the United States and the other G8 industrial powerhouses.
There are no major industrialized countries near the United States in
the rankings. The closest is Italy, at 5.83 infants dying per thousand , but
it is still ranked five places higher.7 In the United States , infant
mortality rates are 7.1 per 1,000, the highest in the industrialized world --
much higher than some of the
poorer states in India, for example, which have public health systems in
place, at least for mothers and infants. Among the inner-city poor in the
United States, more than 8 percent of mothers receive no prenatal care at all
before giving birth.
Overall U.S. mortality We would have expected to see steady decreases in
deaths per thousand in the mid-twentieth century, because so many new drugs
and procedures were becoming available. But neither the Canadian nor the
American mortality rate declined much; in fact, Canada's leveled off for an
entire decade, throughout the 1960s. This was a period in which private care
was increasing in Canadian hospitals, and the steady mortality rates reflect
the fact that most people simply
couldn't afford the new therapies that were being offered. However, beginning
in 1971, the same year that Canada's Medicare was fully applied , official
statistics show that death rates suddenly plummeted, maintaining a steep
decline to their present rate.
In the United States, during the same period, overall mortality rates also
dropped, reflecting medical advances. But they did not drop nearly so
precipitously as those in Canada after 1971. But given that
the United States is the richest country on earth, today's overall mortality
rates are shockingly high, at 8.4 per thousand, compared to Canada's 6.5.
Rich and poor It has become increasingly apparent, as data accumulate, that
the
overall improvement in health in a society with tax-supported health care
translates to better health even for the rich, the group assumed to be the
main beneficiaries of the American-style private system. If
we look just at the 5.7 deaths per thousand among presumably richer, white
babies in the United States, Canada still does better at 4.7, even though the
Canadian figure includes all ethnic groups and all income levels . Perhaps a
one-per-thousand difference doesn't sound
like much. But when measuring mortality, it's huge. If the U.S. infant
mortality rate were the same as Canada's, almost 15,000 more babies would
survive in the United States every year. If we consider the statistics for
the poor, which in the United
States have been classified by race, we find that in 2001, infants born of
black mothers were dying at a rate of 14.2 per thousand. That's a Third World
figure, comparable to Russia's.8 But now that the United States has begun to
do studies based on
income levels instead of race, these "cultural" and genetic explanations are
turning out to be baseless. Infant mortality is highest among the poor,
regardless of race. Vive la diff=E9rence! Genetically , Canadians and
Americans are quite
similar. Our health habits, too, are very much alike -- people in both
countries eat too much and exercise too little. And, like the United States ,
there is plenty of inequality in Canada, too. In terms of health care, that
inequality falls primarily on Canadians in
isolated communities, particularly Native groups, who have poorer access to
medical care and are exposed to greater environmental contamination . The only
major difference between the two countries that could account for the
remarkable disparity in their infant and
adult mortality rates, as well as the amount they spend on health care , is
how they manage their health care systems. The facts are clear : Before 1971,
when both countries had similar, largely privately funded health care systems,
overall survival and
mortality rates were almost identical. The divergence appeared with the
introduction of the single-payer health system in Canada. The solid
statistics amassed since the 1970s point to only one conclusion: like it or
not, believe it makes sense or not, publicly
funded, universally available health care is simply the most powerful
contributing factor to the overall health of the people who live in any
country. And in the United States, we have got the bodies to prove it.
Holly Dressel was born south of Chicago and lives in Montreal, Quebec . She
is a writer/researcher and the best-selling co-author, with David Suzuki, of
Good News for a Change and other works. This article was adapted from Holly
Dressel's book God Save the
Queen God Save Us All: An Examination of Canadian Hospital Care via the Life
and Death of Montreal's Queen Elizabeth Hospital, to be published in 2007 by
McGill/Queen's Press. 1Terry Boychuk. The Making and Meaning of Hospital
Policy in the
United States and Canada. University of Michigan Press, Ann Arbor: 1999 .
2David U. Himmelstein, et al. Health Affairs, Jan. June 2005, http:/ /
content.healthaffairs.org/cgi/reprint/hlthaff.w5.63v1 3Professor James Kahn,
UCSF, quoted in Harper's Magazine, "Harper's List," Feb. 2006. 4National Health
Expenditure Data,
www.cms.hhs.gov/ NationalHealthExpendData/downloads/tables.pdf. 5Devereaux ,
Dr. P.J., et al. "A Systematic Review and Meta-Analysis of Studies Comparing
Mortality between Private For-Profit and Private Not-For -Profit Hospitals,"
Canadian Medical Association Journal,
May, 2002. 6Nancy A. Ross et al. "Relation between income inequality and
mortality in Canada and in the United States: cross sectional assessment using
census data and vital statistics," Statistics Canada, reprinted in Health
Geography, GEOG-303, ed. Nancy Ross,
McGill University, 2005, pp. 109-117. 7CIA World Fact Book. www.cia.gov/cia
/publications/factbook/rankorder/ 2091rank.html 8See, among many studies
blaming race, Child Health USA 2003, Health
Status Infants; HRSA, with graphs such as "Breastfeeding Rates by
Race/Ethnicity, 2001"; "Very Low Birth Weight Among Infants, by Race/Ethnicity
1985-2001"; http://www .mchb.hrsa.gov/chusa03
. -- Robert Felty http://www-personal.umich.edu/~robfelty I took a course
in speed reading and was able to read War and Peace in twenty minutes. ;
It's about Russia.
; -- Woody Allen
------=_Part_4661_29550456.1159680135710--
|
