Posted on | April 4, 2017 | No Comments
At the end of WWII, Canada and the U.S. realized the necessity of focusing on health care infrastructure. There were of course the hundreds of thousands of physical and mental health casualties streaming into overflowing and over-stressed hospitals. Add to this a significant and growing explosion of chronic diseases fed by soldiers and their families embracing tobacco and alcohol, and feeding an explosion of cardiovascular disease, cancers, and psychiatric diseases codified in the first psychiatric classification system, DSM-1.
The Canadians approached the challenge as a planning exercise and ultimately focused on prevention and universal insurance coverage as their starting points. The U.S. took a different road, embracing private scientific enterprise and liberal amounts of national funding to expand scientific research and hospital bed capacity. Insurance coverage in the U.S. was not simply an after-thought. To many, it was a threat, a slippery slope toward socialized medicine, a Communist plot.
Now, more than a half century later, American health continues to suffer. We have been unable and unwilling to “walk back” these decisions, and continue to insist that American scientific brilliance, industrial might, technologic know-how, and massive medical funding will ultimately seize the day. But evidence to the contrary continues to pile up.
Trump’s attempt to dismantle the ACA and downsize Medicaid expansion has boomeranged to the extent that policy analysts have worked hard to expose the negative impacts that would result from eliminating coverage of vulnerable populations. To make their cases, analysts have been exposing some eye-popping comparisons with our neighbors to the north who are all covered under a single payer system.
Case in point: In the March 14, 2017 issue of Annals of Internal Medicine, authors compared the fate of patients followed by the Canadian Cystic Fibrosis Registry to those in the U.S.Cystic Fibrosis Registry. The study included patients from 42 specialty clinics in Canada and 110 clinics in the U.S. Their choice of disease was interesting because it has been a major target of America’s Medical Industrial Complex.
The disease is genetic and incurable, creating excess production of mucous secretions in multiple organs, but especially in the lungs where infected secretions progressively destroy a child and young adult’s breathing capacity. It effects approximately 1 in 10,000 live births in both countries. Effective treatment involves early diagnosis, hands on percussive treatments to clear the mucus, active family and community involvement, break-through pharmaceuticals, and lung transplants for some.
With America’s scientific and technologic might, one would predict that the U.S. would outperform Canada. But here is the sad truth:
1. Canadians with cystic fibrosis live approximately 10 years longer than their counterparts in the U.S. – 50.9 years vs. 40.6 years.
2. The gap in survival has been growing larger over the past two decades.
3. Canadian patients with the disease are afforded lung transplantation with much greater frequency than in the U.S. – 10.3% vs. 6.5%.
4. The factor most directly associated with morbidity and mortality is lack of insurance coverage. U.S. Medicaid patients with the disease fare substantially better than those without insurance.
5. The adjusted risk of death for a patient with the disease in Canada is 34% lower than in the U.S.
6. The newest pharmaceuticals for cystic fibrosis are substantially less expensive in Canada than in the U.S. where some are priced at $250,000 a year.
The Commonwealth Fund authors David Squires and David Blumenthal recently stated that “In medical terms, we might call uninsurance a “comorbidity”—one unique to the United States among all industrialized nations, and just as deadly as pneumonia or diabetes.”
This battle with Trump over the survival of the Affordable Care Act offers a chance to America to start over on health delivery. Scientific know how can not outperform coverage and prevention. That’s been well established. Kids with cystic fibrosis and many other innocents hang in the balance. This is a fight worth having.