Posted on | February 24, 2017 | No Comments
During the Hillary Clinton health care debate of the 1990’s, our approach to health care delivery was compared to multiple other nations – including Canada. Supporters of our status quo worked hard to emphasize other nations differences and weaknesses.
The criticism of Canada, which even then was registering demonstrably better outcomes at a fraction of our cost, was twofold. First our health leaders accused the Canadians of rationing services and delaying life-saving treatments. And second, they claimed that our neighbors were able to get away with this because we were on their southern border, and Canadians in large numbers emigrated to our institutions to get access to services denied by their own niggardly system. Additionally we claimed that Canadian doctors were so dissatisfied with their system that they were routinely relocating to the U.S. to practice medicine.
These paired and interdependent false realities were presented with such certainty, and reinforced by our own medical elites so consistently, that physicians like myself bought into the propaganda without critically examining the facts. It was a full decade before these false claims were analyzed in earnest. In 2002, four health policy experts, with the support of the Canadian Medical Council, which had renamed itself the Canadian Institutes of Health Research, established unequivocally that the claims of medical migration, by either patients or their doctors, were bogus.
The Health Affairs publication, titled “Phantoms in the Snow: Canadians’ Use of Health Care Services in the United States”, didn’t mince words. Backed up with an array of facts and figures, and exhaustive documentation, the authors stated, “Results from these sources do not support the widespread perception that Canadian residents seek care extensively in the United States. Indeed, the numbers found are so small as to be barely detectible relative to the use of care by Canadians at home.”
On the Canadian side, only 90 of 18,000 citizens surveyed had used American services, and the vast majority of these were tourists seeking emergency care while traveling. Surveys of major U.S. academic centers, including those in border states reinforced the same conclusion: few if any Canadians. In the end, the authors concluded, “The numbers of true medical refugees—Canadians coming south with their own money to purchase U.S. health care—appear to be handfuls rather than hordes.” The same held true for Canadian doctors who had little to no interest in relocating.
Concurrent studies did reveal that Canadian waits for certain elective procedures and access to high tech diagnostics were longer than in the U.S. This fully transparent trade-off, made by provincial and territorial health governing bodies, was largely supported by Canadians as necessary and responsible budget management of priorities. They never hid the fact, but rather raised it in the public square. And recent corrective measures have not been entirely successful. (Message: Canada’s health care system does continue to have its own challenges.)
Absent proof of an escape valve migration south, U.S. detractors continued to wave the bloody flag of rationing, even as studies of our own system revealed that our population is more likely than citizens from other developed nations to put off needed treatment because they can’t afford it – de-facto financial self-rationing if you will.
In 2003, the U.S. under President George W. Bush continued to struggle to control health care costs. The nation’s response, with the opaque support of PhARMA, the AMA and AAMC, and the hospital and insurance industries, was to approve Medicare Part D’s non-negotiable coverage of pharmaceuticals for seniors at prices roughly 150% of the cost of Canadian counterparts.
Gallop polls at the time found that 57% of Canadians were “very” or “somewhat” satisfied with their health care system compared to 25% of Americans. 44% of our citizens were “very dissatisfied” while only 17% of Canadians felt the same. Part of the reason for relative calm up north was that their system was continuing to evolve in the full light of day. What were they up to?
In 2004, Canada’s Prime Minister and the provincial and territorial leaders announced “A 10-Year Plan to Strengthen Health Care”. Their opening statement? “As a nation, we aspire to a Canada in which every person is as healthy as they can be-physically, mentally, emotionally and spiritually.” Their guiding principles don’t sound like ours – no words like innovation, entrepreneurship, precision health or highly leveraged technologic wonders; no battles for ever increasing research funding by competing diseases; no academic goliaths with million dollar CEO’s overseeing patent producing enterprises as patient care takes a back seat.
What are their benchmarks and how is Canada performing compared to the US these days? More on that next week.