Has Canada Got the Cure?
by Holly Dressel
www.alternet.org, August 29, 2006
Should 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
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. 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.
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. 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.
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."
"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. 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
in income resulted in a mortality decline of nearly 22 out of
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 rates, which reflect
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
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
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
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.
This article was reprinted from Yes! A
Journal of Positive Futures, PO Box 10818, Bainbridge Island,
WA 98110. Subscriptions: 800/937-4451.
Holly Dressel is the co-author of Good
News for a Change. This article was adapted from her forthcoming
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" (McGill/Queen's Press, 2007).