Kudos to socialized medicine

A closer look at the US healthcare system reveals hidden costs and serious gaps in coverage

by Mike Keep

I am a Canadian currently attending an American medical school. Today, I began a course in Health Systems, which is essentially an introduction to the United States' medical system.

The US system offers arguably the most advanced healthcare in the world, yet also the most expensive and disturbingly exclusive. I asked one of my American suitemates to explain the system to me prior to the beginning of the course, because its intricacies seemed too detailed and numerous to piece together on my own.

Unfortunately, he was not certain how it worked. This is not uncommon amongst the American students here. In general, their idea of medicine is that commodity-based health care (the US system), is good and that socialized, government-operated healthcare (the Canadian system), is bad.

Here are the facts. In recent years, Canadian healthcare spending per capita has been lower than in the US, even though on average, Canadians will visit the doctor more often and stay in the hospital longer. Canadians undergo the same treatments and take the same drugs, but we do it much cheaper. The US spends up to 300% more money than Canadians per capita to administer their healthcare system, and their overall healthcare spending is 40% higher than Canada's.

The Canadian approach is simple: a large company is obligated to provide health coverage for its fulltime employees. For those who aren't covered through a strictly regulated private insurance carrier via their employer, they will simply be covered by the respective provincial government in which they reside.

In the US, they have private insurance-Medicaid, Medicare, and the Health M aintenance Organization (HMO) system-as well as other systems to deliver a private/public healthcare. Overall, the difference in medical infrastructure is minimal between Canada and the US, but the delivery system is markedly different. For example, 55% of Canadian doctors are General Practitioners, acting as gatekeepers to the system and responsible for sending their patients to qualified specialists, should the need arise. The US has only 35% of its physicians wearing the General Practitioner's hat because Americans mostly seek out their own specialist care, cutting out the "middle man" to save money, which results in their making uninformed decisions about their course of treatment.

I explain to those Americans who criticize Canada for having long waitlists, that given an emergency, a person will be bumped right to the top of the list. If Mr Smith requires a knee operation, he will wait an average of three weeks for the procedure in the US, but up to eight weeks in Canada. This is not a life-threatening situation. Now, if Mr Smith is diagnosed with leukemia, he will be treated as quickly in Canada as he would in the US. The primary difference is that in Canada he won't have to worry about whether his insurance will cover all of his treatment, and how much it will eventually cost him out of his own pocket.

We have learned that it is key in medical treatment to minimize the patient's stress, as doing so is positively correlated with increased immune system function. Now, for the majority of people who worry about money, being in a US hospital will be very stressful. You'll be given a situation where you are lying in your hospital bed trying to figure out how you'll pay for the treatments while in the meantime, you're experiencing immune system depression and likely a confounding illness.

There is an inherent danger in commodity-based health care that when people aren't getting sick and requiring procedures, then doctors aren't making any money. As a result, approximately 25% of medical procedures are unnecessary in the US. Essentially, there are a lot of happy doctors who can afford car payments, but many unhappy patients with unnecessary coronary artery grafts on their hearts. Medicine is big business and that is why the doctors make a lot more money in the US than their Canadian counterparts.

Overall, the most alarming statistic is that there are 45 million people in the United States that go without healthcare because they are uninsured, but who still earn just over the minimum poverty line amount, meaning there will be little government support to help them and their immediate family.

Granted, neither system is perfect, but it is one less thing that we as Canadians have to concern ourselves with. Of course, Americans pay less taxes than we do, but at what cost? Everybody gets sick. The average Canadian pays up to 40% of their annual income to taxes, but up to 22% of the money taken in by the government is dished out for healthcare spending. The federal government contribution to healthcare alone costs about 9.5% of the budget and the provincial governments carry the rest of the cost burden. In contrast, the US federal government is still spending about 13.5% of its budget to provide their "pseudo-social support" for healthcare.

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