Has Canada Got the Cure?
By Holly Dressel, YES! Magazine
Posted on August 29, 2006, Printed on August 30, 2021
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
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
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
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
In a massive study
undertaken by Statistics Canada in the early 1990s, income and mortality
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 &ndash between income inequality and
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 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 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
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.
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
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
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.
This article was reprinted from Yes! A Journal of Positive Futures,
PO Box 10818, Bainbridge Island, WA 98110. Subscriptions: 800/937-4451.
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
© 2006 Independent
Media Institute. All rights reserved.
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