Tuesday, January 28, 2014

Canadian Health Care and Why Americans "Can't Politics"

In this post, I will be discussing common misconceptions of the Canadian health care system. Perhaps the title of this post is too generalizing and offensive, but allow me to defend my position. Anyone in America who watches the news somewhat frequently knows of the arguments I will be referring to, and many of you will be aligned with this sort of thinking. At the same time, I acknowledge that the vast majority of Canadians who are familiar with our health care system do not need to be informed of these facts, although they may be familiar with the debate in America, and that many Americans are also not aligned with these thoughts. My goal here primarily is to address individuals residing in America who have been socialized with the misinformation being passed around in their common media about Canada's health care system, and similar systems in general. Hopefully I can successfully unhinge a few people from their fears of a single-payer health care system.

As I said above, I acknowledge that most Canadians know the facts already, but this goes into a deeper issue within this topic, and is quite relevant. In November of 2009, Nanos Research conducted a poll of 1,005 Canadians by telephone to find their opinions of our health care system. It was found that 79.9% give their endorsement of the health care system, while about 10% are still somewhat supportive, amounting to a general ~90% approval rating. The strongest approval rating was 83% in Ontario, my province, while there exists no significant regional variation. Please note, before I continue, that this is the unqualified opinion of Canadian citizens, not professionals in the medical field. We'll get to that later.

This same poll asked a question about the Canadian citizens' opinion of United States President Barack Obama's endorsement and pursuit of a public health care system. 71.3% expressed that they believe Barack Obama is "on the right track," while only 7.3% stated disapproval. The rest were unsure, which is to be expected. Again, the highest rate of approval was found in Ontario.

So everyone can see the specific results.
So now that we've established that most Canadians approve of public health care, I want to take a moment to be fair to the other side. Most Americans will refer to the fact that Canadians evidently report of extreme waiting times for procedures and operations. The same poll conducted above asked two specific opinionated questions. The first question asks what Canadians think is the key strength of our health care system. 61.4% answered that it was free public health care that was accessible to everyone. The second question asked what we think is the weakest aspect. Consistent with the opposition's claims, 32.7% responded that waiting times/lack of accessibility were the biggest issues. Note, this does not mean that 32.7% of Canadians believe there are outrageous waiting times -- just that if they had to pick, this would be the primary issue.

Waiting times are not the only factor that might lead Canadians to come to America to receive health care. Canada is actually behind in terms of new technology for certain procedures, such as cranial tumors or brain injury. Sometimes hospitals are in more convenient locations as well for Canadians living close to the border, and American hospitals, as it seems to me, are generally superior, especially because of the greater numbers in staff.

However, despite these contentions, it doesn't imply that the article linked at the beginning of this post is assuming correctly. In fact, all of the possibilities I listed above have been found to have little-to-no effect on Canadians traveling outside of Canada for medical treatment. A study conducted by Katz et al. in 2002 examined Canadians traveling to the United States for such purposes. They used data from the National Population Health Survey (NPHS) to find survey responses to two questions. The first question asked if the respondent received medical care in the United States during the past twelve months of their response. If the respondent answered "yes," the next question asked if they went to the United States primarily for such services.

They also collected data by contacting, via telephone, all ambulatory care facilities located in the United States close to the Canadian border in densely populated areas. The reason for this was to get the most accurate response, since it is assumed that if Canadians were to go to the United States for medical treatment, they would choose a location close to Canada. They asked key informants within these institutions for the number of Canadians they had seen in the prior year, and to indicate any significant trend.

Lastly, they contacted statewide hospital discharge data from 136 ambulatory care facilities in New York, Michigan and Washington, asking how many Canadians they admitted into the hospital according to admission status (and not by coincidental activity). They also selected for "America's Best Hospitals" to find a relevant trend. The results were as follows:

Approximately 40% of facilities contacted had seen no Canadians in the prior twelve months, 40% had seen fewer than ten, 15% had treated 10 - 25 patients, and 5% reported seeing more than 25 (although none reported seeing more than 100, the number was generally between 25 and 75). If we extrapolate the data, there were 640 Canadians who received treatment for diagnostic radiology services and 270 patients for eye procedures in America over that year. However, in British Columbia over a 5-year period, there were 80,000 and 25,000 procedures respectively, and for Quebec, 375,000 and 44,000 procedures respectively. It is important to note that this comparison is extrapolated, and the comparison is between two five-year periods and the study's one-year period; however, at the same time, we must consider that the comparison is only being made to two regions of Canada.

In the three states observed for hospital discharge data, ~4,500 Canadians received treatment; however, approximately 80% of such treatment was related to pregnancy.

For the NPHS results, of the 18,000 respondents in 1996, only 90 said they had received treatment in the United States, and of those, only 20 stated they went to America expressly to do so.

Some of these visits, notably, were as a result of contract provisions. In October of 1999, Quebec contracted with three radiation centers in Vermont and Maine. In the subsequent year, 1,030 patients were treated. Ontario did the same in March of 1999 with three health care organizations in Michigan, New York and Ohio. Subsequently, 1,416 patients were treated. This already accounts for about 8.5% of prostate and breast cancer patients from Canada during that time frame.

Robbed from the AARP debunk article.
So in summation, only 5% of the examined facilities saw a significant number of Canadian patients, and ~0.11% of Canadians go to America for medical treatment. This suggests that while Canadians have contentions with the health care system, a very small number come to America for their procedures, and most Canadians do approve of the health care system. The reason is because the waiting times have nothing to do with the fact that Canada uses a single-payer system. It has to deal with what percentage of the country's GDP is spent on health care.

For Canada, it's 9.9%, according to the Organization for Economic Cooperation and Development (OECD) in 2004. For the United States, it's 15.3%. This is something intuitively obvious to people familiar with economics. Simply put, the less money people spend on medical services, the more likely they are to be restricted on their access to those services. This same principle applies to many fields.

So, Canadians approve of the health care system, because the waiting times are irrelevant to the type of system. But what of Canadian physicians?

Sampling and other data.
As I mentioned of the Nanos Research study, the poll only asked in regards to public opinion; however, another poll was conducted by Schoen et al. in 2009 to find opinions of physicians from 11 countries in regards to their satisfaction in their practice. There were 1,401 responses in Canada and 1,442 in the United States. Of the physicians in Canada, approximately 54% expressed satisfaction, and 21% said they were very satisfied. In the United States, 49% said they were satisfied, while 15% said they were very satisfied. So it seems there is not much of a significant difference between the two approval ratings; although, the rating is higher in Canada.

Both Canadian citizens and Canadian physicians enjoy the health care system for the most part. This was never anything complicated, but sometimes, it takes some true data to get rid of any misconceptions. When political agendas are in mind, it's very difficult not to make comparisons, and often times, these comparisons are faulty. There are plenty of countries which are satisfied with public health insurance (just look at Scandinavia), and there are plenty which are satisfied with either a combination of public and private, or just private. We can't just dismiss an entire system and say "it doesn't work," because so many variables are involved in whether or not a system works. The system itself isn't always at fault, and even if it were in one country, that says nothing about how it would work for another. This is a vital principle of politics in general -- context.

I've lived in America for most of my life (more than I have in Canada; in fact, I've barely spent more of my life in Canada than Japan). I'm familiar with the politics. It's hard to say whether one system will be better than another, but all I can say is, it just takes honest consideration as opposed to terrorizing buzzwords like "socialism." Things like this are very dangerous, because they divert to simple ideological differences as opposed to arguments over practical application. This is much of the reason why I have dropped any explicit affiliation with a political party (or "faction" if you're an early democratic or a Marxist). I plan to make my next post a work by my father, but in the future, I'll make a post about my views on politics in general.

Until then, thank you for reading.

*If you want to see the AARP's version, which has a lot of the information I used in my post, follow this link.

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  1. I love these thorough posts on specific topics. I do have a few things to ask, though.

    First, let me say that I absolutely love this blog. I can easily follow what you're saying without having much prior knowledge in anything (except statistics), and it seems that aside from your individual values, you're less biased than the average human being who likes to argue. I first read your blog from your abstract post "Why Original Thoughts Don't Exist," and then I got absolutely hooked after your page on "LaughingMan0X vs Sam Owl".

    But aside from all of that, I have a few questions, if you don't mind answering:

    #1 - Why do you focus so heavily on the works of your father?
    #2 - Why do your topics seem to address very specific issues as opposed to large groups of issues. For example, a refutation of a single race realist instead of refuting all of race realism?
    #3 - What political party did you used to affiliate yourself with, and why do you not affiliate with it now?
    #4 - You say you go to Uni. What is your major(s)?
    #5 - Aside from your major(s), what do you consider your primary scholarly interest?
    #6 - Stemming from your apparent interest (at least somewhat) in genetics, evolution and anthropology, what do you make of "Lewontin's Fallacy"?

    1. You're lucky to have caught me just now, since I'm usually really busy!

      Thank you for your support of my blog. I encourage you to continue commenting and start/participate in any future discussions. I welcome dissenting opinions, so long as they're appropriate (you'll find I stick by the doctrine "freedom of speech to the extent of public order). Let me answer your questions as thoroughly as I can!

      Question 1: I focus heavily on the works of my father for a few reasons. When you write something down on paper, or type it on a computer, you begin to understand it more, because it takes a certain amount of recreation in your mind to understand what you're typing, so you know that what you're putting down makes sense. I didn't know my father as well as I would've liked to -- he was around for my childhood and early teenage years. Now that I know what I do, I want to understand him more, because I see him as being a very intelligent man. By posting his works here, as well, I can share with the world what wisdom he had to offer.

      Question 2: This is an amazing question, and it will take a long time to fully explain. If you don't mind, can I save it for a future post?

      Question 3: I used to identify myself as a libertarian, specifically a minarchist. I don't affiliate myself with it now because I refuse to affiliate myself with any political party, faction, group, etc. I'd also like to include my reasoning, for that, in the future post.

      Question 4: I dual major: fine arts with a concentration in graphic design, and psychology with a concentration in developmental psychology (although I enjoy studying cognitive as well).

      Question 5: Primary scholarly interest? That varies greatly. I love studying philosophy and logic, anthropology, political sciences, music, and much more. When there's so much information in the world, it's hard to just pick one.

      Question 6: Lewontin's Fallacy... strangely specific. I'd like to save this for another post, as well.

    2. Two posts from questions I posed? Great! I look forward to them!

      Thank you for your responses. I totally understand how you feel about your father, and so I hope you'll place the post with his work with precedence. :)


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