On One Hand

July 12, 2009

Comparing U.S. and Canadian Heathcare is Silly – But if you do, Canada Wins

Filed under: Uncategorized — ononehand @ 8:02 pm

Rhonda Hackett, a Canadian and healthcare provider who has spent years living in the United States, explains:

As a Canadian living in the United States for the past 17 years, I am frequently asked by Americans and Canadians alike to declare one health care system as the better one.

Often I’ll avoid answering, regardless of the questioner’s nationality. To choose one or the other system usually translates into a heated discussion of each one’s merits, pitfalls, and an intense recitation of commonly cited statistical comparisons of the two systems.

Because if the only way we compared the two systems was with statistics, there is a clear victor. It is becoming increasingly more difficult to dispute the fact that Canada spends less money on health care to get better outcomes.

I have to concur. Any discussion you seek to have will inevitably lead to very subjective views on Canadian waiting lists or a lack of specialists there. They’ll point out that many Canadians travel to the U.S. for procedures that otherwise have long waiting lists (a moot point, as many Americans travel to Mexico and Thailand for surgical operations all the time. Is that information sufficient to reach a general conclusion that Thailand has a more advanced medical system than the United States?)

But at the end of the day, illogically reduced or decontextualized statistical bits of information lead to two important pieces of information:

Who spends less on healthcare, overall?
Who had better outcomes, overall?

And ultimately, Canada spends less on healthcare and has lower death rates for diseases needing medical attention.

Read “Debunking Canadian Health Care Myths”

Now I’m open to a healthcare landscape far more economically conservative, and far more market-oriented, than Canada’s, and am willing to leave private health insurers in place as long as everyone can choose to purchase health insurance through a public option. But this is once again clear evidence that doing nothing is a moral travesty, and a drastic government takeover of health insurance – even one we do not like, to make American healthcare resemble Canadian healthcare – would still be better than what we have today.



  1. This was a great article. I was surprised it was getting so many great reader recommendations on denverpost.com, but I guess maybe the American public is finally ready for the truth and for change in the health care system.

    Comment by lemonnada — July 13, 2009 @ 4:31 am | Reply

  2. Comment

    I have had one recurring thought when reading your recent posts on healthcare. You seem to be certain that some reform will be better than no reform. If that is indeed the case, then I am curious what is the source of this certainty?

    To be more specific, I agree with many of your comments and recitation of the facts regarding our current healthcare system. There are many aspects of our system that are inefficient, wasteful and generally sub-optimal.

    I believe that we generally start at the same place in this analysis. Public policy has the capacity to change and make vast improvements in this situation. However, at this point in time, I have not seen clear indication that the proposed plans coming together will do this. That does not mean that a coherent plan will not take shape. I reserve any confidence or optimism until policymakers present a compelling case.

    My point is this: it remains a distinct possibility that due to unintended consequences or political realities, we end up with proposals that make us worse off. Without getting bogged down here, I’ll refer to Ezra Klein, a self-identified liberal writing for the Washington Post,


    There are of course other pitfalls that could beset a public plan. Slightly differently, it’s also feasible that the best way to reform is to
    entirely gut the private insurance over time in a gradual, very direct fashion. (I am saying this without respect to political realities).

    At the end of the day, it does not seem to me that the path from A to B is clear at this time. To me, it seems important that we refrain preference from specific policy measures (a public plan) until they are completely flushed out in full detail, which has not been done yet.

    Comment by sleepyreaderz — July 13, 2009 @ 6:28 am | Reply

    • Re: Comment

      I have had one recurring thought when reading your recent posts on healthcare. You seem to be certain that some reform will be better than no reform. If that is indeed the case, then I am curious what is the source of this certainty?

      That is a meta-level attack on the concept of action in general and it’s not a fair argument. The burden is on you to come up with an argument of why a public option wouldn’t work other than saying an argument may exist. If one individual’s personal uncertainty were sufficient to derail another person’s agenda, he could point to any person on Earth and say they ought not to act on their goals because of his uncertainty or lack of understanding of the other person’s reasoning.

      If we end up with a proposal that clearly makes things worse, we should not select that proposal! And if there is some possibility of unintended pitfalls that we don’t realize until after the fact, than this is no different than any endeavor in human history, since all of them could have contained unforeseen pitfalls. What I read your comment as saying is, essentially, human beings or societies should not seek to solve problems because of uncertainty.

      If I misunderstood you, and you were instead saying, more specifically, that it is impossible to increase access to healthcare or lower costs, all I would do is point you to all the countries that have better healthcare and lower cost than the United States. It is possible because it is real. We could try to duplicate their plans, or if we find them insufficient, we should try to come up with an alternative plan that is better. But again, citing some yet unseen obstacle does not justify inaction.

      Your link to Exra Klein is something I can comment on – and I’m glad to see it because I think it’s proof that private health insurance alone doesn’t work. I would say that a good public option may eventually require taxpayer funding or the government would have to keep people currently on Medicare and Medicaid on that, and out of the public option. There are a number of solutions I can think of to the problem listed.

      But, again, saying “there may be more issues like this down the line” is not going to work. There is no additional information or research that could make this problem easier to solve if we wait, so appealing for more information is no good. If you think there could be problems it is your responsibility to name them.

      Comment by ononehand — July 13, 2009 @ 7:46 am | Reply

      • Re: Comment

        I’ll begin with the shorter point you bring up. I am not at all saying:

        “that it is impossible to increase access to healthcare or lower costs.”

        Further, I am not attacking the general idea of a public option. I’m not attacking the idea of reforming the healthcare system. I am in favor of reforming the system, as a general matter.

        Again, I stress that, from what I have read on your blog, we agree on the facts regarding the inefficicies present in the system.

        Now, on to another issue. You write:

        “The burden is on you to come up with an argument of why a public option wouldn’t work other than saying an argument may exist.”

        That is exactly why I linked to Ezra Klein’s article – he pointed out how a potential situation could realistically come about that may result in an inefficienct public option. He didn’t say it would certainly happen either. He just pointed to a problem.

        My point is that that’s a problem and it hasn’t been addressed.

        Overall, the burden of proof for policymakers is to convince the public (and themselves) that the proposed reforms – whatever they may be – will function properly, will achieve their goals. Again, I linked to Ezra’s point above because I felt like it was a sufficient point that has not been addressed by any of the current details revealed about healthcare reform.

        Again, to be clear about my position, I’m not saying I am against or for any current proposals of healthcare. The legislative process is still moving. The details will matter in terms of the effective outcome. So, I reserve judgement until I can review definitive proposals.

        The original entry point of this post was that I was unsure why you took a position of such confidence regarding this issue. Perhaps I misinterpreted your tone. From my reading of your posts, I believed you were very certain that any type of reform would be preferable – would make health care better. That’s not at all clear to me at this preliminary point. Some problems remain unaddressed (Ezra’s point about selection, the problem of operationally sorting out the subsidy level of a public option, etc). Those are sufficient justifications for me to be uncertain and want to see these points be addressed in the proposed reforms.

        Comment by sleepyreaderz — July 18, 2009 @ 2:02 am

      • Re: Comment

        I’m very specific about the form of healthcare reform I want to see; I see the greatest risk in passing some watered-down version of the bill that fails to solve the problem, but convinces the public that the problem has been solved and that things are better now. If a plan were to drive down costs for a few crucial middle and upper-middle class customers, but failed to cover low-income people, we would have essentially zapped our ability to do the moral thing on healthcare in America.

        What I am very specific about is a public option. The judgment call I have made is that it is the best option available to us now because it opens enough doors to solve problems with enough of a chance to pass. I will not, of course, ever be able to disprove any theoretical downside of a public option but would argue that it is better than the alternatives, which also have downsides.

        I want a direct relationship between the patient and the government and I want anyone to be able choose that option regardless of income. It gives individuals the right to get away from a private system they consider immoral (I don’t want my own money to be going to a corrupt private insurance system that makes a game of excluding sick people from coverage) and I am sure that many people across the income spectrum would like to buy into such a system for similar reasons. Of course there will be shortcomings we don’t know about right now. Down the line, it will be much easier to amend a public option to resolve unforeseeable problems, than it will be to enact one if we miss this window of opportunity.

        I don’t think it’s really possible for us to solve the next 50 or even 10 years of healthcare needs right now, because we can’t predict the problems. But we can, however, make a judgement call on what is best right now, enact that, and work to improve it when it begins to operate and we can examine where the kinks are.

        I can’t comment on any more specific problems a public option plan would create because there has not been a plan yet. We only just recently got something of substance to look at in the House and it is bound to change before anybody votes on it. Perhaps something worth commenting on will appear shortly.

        Comment by ononehand — July 19, 2009 @ 10:19 pm

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