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 03
Text pasted below
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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 différence! 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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